What's on this Page
In patients with GI bleeding caused by PUD, what are the predictors for rebleeding in the hospital? What is the Forrest classification?
- Hemodynamic instability (systolic blood pressure < 100 mm Hg, heart rate > 100-110 beats per minute)
- Large ulcer size (> 1-2cm)
- Ulcer location (posterior duodenal wall, high lesser curvature)
- Active bleeding during endoscopy
- Hematocrit less than 30
- Multiple comorbidities
- Coagulopathy
- Hematemesis
- Inability to clear the stomach with aggressive lavage
Forrest Classification of Peptic Ulcers
| Forrest Classification | Description of Endoscopic Stigmata | Treatment | Rebleeding Rate without Endoscopic Therapy | Mortality without Endoscopic Therapy |
|---|---|---|---|---|
| 1A | Spurting blood | IV PPI bolus + infusion, endoscopic treatment | 70% | 11% |
| 1B | Oozing blood | IV PPI bolus + infusion, endoscopic treatment | 30% | |
| IIA | Nonbleeding visible vessel | IV PPI bolus + infusion, endoscopic treatment | 43% | 11% |
| IIB | Adherent clot | IV PPI bolus + infusion, consider endoscopic treatment | 22% | 7% |
| IIC | Pigmented flat spot | Oral PPI | 10% | 3% |
| III | Clean based ulcer | 5% | 2% |
IV, Intravenous; PPI, proton pump inhibitor.
Sources
Adapted from Laine L, et al. Management of patients with ulcer bleeding. Am J Gastroenterol 2012;107(3):345–360.
