Forrest Classification (Bleeding Peptic Ulcer)
Grades a bleeding peptic ulcer from what endoscopy shows.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Endoscopic finding at the ulcer base
- iia
Result: Forrest IIa
The tool opens with these values already filled in. Replace them with your own.
What the result means
- Ia, Ib, IIa
- High risk. Spurting, oozing, or a non-bleeding visible vessel. Endoscopic hemostasis is indicated; epinephrine injection should not be used alone.
- IIb
- Adherent clot resistant to washing. Trials of endoscopic therapy disagree, so guidelines are equivocal. Reported rebleeding is roughly 22 to 33 percent untreated.
- IIc, III
- Low risk. A flat pigmented spot or a clean base. Endoscopic hemostasis is not indicated and acid suppression alone is usual.
- Not a ladder
- A non-bleeding visible vessel (IIa) rebleeds more often than an oozing ulcer (Ib), so ranking the classes by roman numeral gets the risk backwards.
What you enter
- Endoscopic finding at the ulcer base
How this is calculated
Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet. 1974;2(7877):394-397. Management posture: Laine L, Barkun AN, Saltzman JR, et al. Am J Gastroenterol. 2021;116(5):899-917. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.