Gastrointestinal Bleeding: Classification

Ulcer bleeding (bleeding from an ulcer) is the most common cause of upper gastrointestinal bleeding (OGIB), accounting for approximately 50%. Of these, duodenal ulcers account for approximately 26% and gastric ulcers account for approximately 24%.

Ulcer bleeding is classified according to Forrest classification

Stage Bleeding activity (recurrence risk/recurrence without therapy in %) [recurrent bleeding after therapy].
I Active bleeding
  • Ia: Injecting arterial hemorrhage (55-90%) [20-50%.
  • Ib: oozing hemorrhage (5-10%) [5-10%]
II Inactive bleeding
  • IIa: Thrombosed (non-bleeding) vascular stump (30-50%) [15-30%].
  • IIb: Adherent coagulum (blood clot) (22-30%) [5-20%]
  • IIc: Hematin at the base of the ulcer (5-10 %) [< 5 %]
III Lesion without signs of bleeding
  • No visible bleeding source with positive bleeding history (3-5%) [<3%].