Forrest classification
# 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.

