Unifying Concepts

Classification of Ulcer-Related Upper Gastrointestinal Bleeding

The Forrest classification is a widely used classification of ulcer-related upper gastrointestinal bleeding. It was initially developed to unify the description of ulcer bleeding for better communication amongst endoscopists. However, the Forrest Classification is now used as a tool to identify patients who are at an increased risk for bleeding, rebleeding and mortality.Forrest Classification

Acute haemorrhage
Forrest Ia Active spurter
Forrest Ib Active oozing
Signs of recent haemorrhage
Forrest IIa Non-bleeding visible vessel
Forrest IIb Adherent clot
Forrest IIc Flat pigmented haematin on ulcer base
Lesions without active bleeding
Forrest III Clean-based ulcer



  1. Kim DS, Jung Y, Rhee HS, Lee SJ, Jo YG, Kim JH, Park JM, Chung IK, Cho YS, Lee TH, Park SH, Kim SJ. Usefulness of the Forrest Classification to Predict Artificial Ulcer Rebleeding during Second-Look Endoscopy after Endoscopic Submucosal Dissection. Clin Endosc. 2016 May;49(3):273-81. [Medline]
  2. Nelms DW, Pelaez CA. The Acute Upper Gastrointestinal Bleed. Surg Clin North Am. 2018 Oct;98(5):1047-1057. [Medline]


Created Dec, 04, 2019

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