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Forrest classification

Classifies endoscopic ulcer appearance (active bleeding, recent bleeding stigmata or clean base), predicting rebleeding risk and guiding endoscopic haemostasis.

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Check the population, units and version. The result shows the formula or classification; it does not make an automatic treatment decision.

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Method · Limits of application

Forrest 1974: Ia/Ib/IIa/IIb/IIc/III; ESGE 2021 context

Forrest classifies the endoscopic appearance of a bleeding peptic ulcer, not every gastrointestinal hemorrhage. Select the class from the examination; the tool does not analyze images or identify the cause of bleeding. The 2021 ESGE guideline recognizes limitations in agreement between observers. The class and any historical percentages alone do not provide an individual prediction of rebleeding or determine discharge or treatment.

Conditions of use

Check the population, units, inclusion and exclusion criteria, and version in the original source. A result alone does not establish a diagnosis, discharge decision or prescription.

Documented parameters

Endoscopic appearance of the ulcer

4/4 reference cases checked. Numerical tests are not clinical validation.

Sources and documentation

Documented formula

Transcribed from the source or a recorded revision; this is not a clinical recommendation.

Forrest I (active bleeding): Ia spurting, Ib oozing. Forrest II (stigmata of recent bleeding): IIa visible vessel, IIb adherent clot, IIc flat haematin. Forrest III: clean base.

References

Identifier: classificacao-de-forrest

Original clinical content: Brazilian Portuguese.

Method version

Forrest 1974: Ia/Ib/IIa/IIb/IIc/III; ESGE 2021 context

classificacao-de-forrest@native-2026-10-03+deddbce0102d

Source for the active edition

The bibliographic edition identifies the source. By itself, it proves neither full conformity of the formula nor clinical approval.

Synthetic cases checked (4)

Synthetic cases for checking the implementation, with no patient data.

Case 1

reference-001

Inputs

Endoscopic appearance of the ulcer: Ia – active spurting bleeding

{
  "classe": "Ia"
}

Expected result

{
  "main": "Ia",
  "level": "high",
  "verdict": "hemostasia endoscópica indicada"
}

Actual result

{
  "classe": "Ia"
}

Case 2

reference-002

Inputs

Endoscopic appearance of the ulcer: IIa – nonbleeding visible vessel

{
  "classe": "IIa"
}

Expected result

{
  "main": "IIa",
  "level": "high",
  "verdict": "vaso visível"
}

Actual result

{
  "classe": "IIa"
}

Case 3

reference-003

Inputs

Endoscopic appearance of the ulcer: IIb – adherent clot

{
  "classe": "IIb"
}

Expected result

{
  "main": "IIb",
  "level": "mid",
  "verdict": "coágulo"
}

Actual result

{
  "classe": "IIb"
}

Case 4

reference-004

Inputs

Endoscopic appearance of the ulcer: III – clean base (fibrin)

{
  "classe": "III"
}

Expected result

{
  "main": "III",
  "level": "low",
  "verdict": "não indicada"
}

Actual result

{
  "classe": "III"
}

Code and reproducibility

This tool’s code on GitHub

Download code and tests

Sources, version and reproduction instructions

The code tests are technical checks. Clinical approval and professional translation review are recorded separately.

Relationship with cancer research

General context — relationship to be defined

A resource for general clinical contexts. This edition does not assign a specific oncological relationship; selecting it for a study requires a justified question, population and purpose.