Forrest Classification

The Forrest Classification is a crucial endoscopic classification system used to assess the risk of re-bleeding in patients with upper gastrointestinal hemorrhage caused by peptic ulcers. During the endoscopy exam, the ulcer is classified based on its appearance and stigmata of bleeding. The classification is divided into three main categories: Forrest I (active bleeding), which is subdivided into Ia (spurting arterial bleeding) and Ib (oozing venous bleeding); Forrest II (stigmata of recent hemorrhage), which includes IIa (non-bleeding visible vessel), IIb (adherent clot), and IIc (flat pigmented spot or hematin); and Forrest III (clean base, no stigmata). This risk stratification is fundamental for determining clinical management and the need for intervention. High-risk lesions, such as Forrest Ia through IIb, have a high probability of re-bleeding and generally require immediate endoscopic hemostasis (like clipping or thermal therapy) combined with aggressive medical therapy (high-dose proton pump inhibitors). In contrast, low-risk lesions (Forrest IIc and III) have a very favorable prognosis and may be managed with medication alone, allowing for earlier hospital discharge.