Forrest classification

Forrest classification is a classification of upper gastrointestinal hemorrhage used for purposes of comparison and in selecting patients for endoscopic treatment.

Forrest classification


Acute hemorrhage
 * Forrest I a (Spurting hemorrhage)
 * Forrest I b (Oozing hemorrhage)

Signs of recent hemorrhage
 * Forrest II a (Non bleeding Visible vessel)
 * Forrest II b (Adherent clot)
 * Forrest II c (Flat pigmented haematin (coffee ground base) on ulcer base)

Lesions without active bleeding
 * Forrest III (Lesions without signs of recent hemorrhage or fibrin-covered clean ulcer base)

Application
Forrest's classification is instrumental when stratifying patients with upper gastrointestinal hemorrhage into high and low risk categories for mortality. It is also a significant method of prediction of the risk of rebleeding and very often is used for evaluation of the endoscopic intervention modalities. A prospective controlled study revealed that "Forrest criteria are essential for proper planning of endoscopic therapy and urgent surgery in bleeding peptic ulcers".

History
The classification was first published by J.A. Forrest, et al. in the Lancet in 1974.