A 45-year-old woman presents with epigastric pain, dyspepsia, and melena. OGD shows a gastric ulcer with a Forrest classification of Ia. Which Forrest class does this represent and what is the recommended management?
- A Forrest Ia = clean-based ulcer; discharge with PPI
- B Forrest Ia = flat pigmented spot; observe and recheck in 24 hours
- C Forrest Ia = adherent clot; proceed to surgical intervention
- D Forrest Ia = actively bleeding (spurting); requires endoscopic hemostasis with adrenaline injection + mechanical clip ✓
Explanation
The Forrest classification of peptic ulcer bleeding: Ia = active arterial spurting (highest risk, 55% re-bleeding rate); Ib = active oozing; IIa = non-bleeding visible vessel; IIb = adherent clot; IIc = flat pigmented spot; III = clean-based ulcer (lowest risk). Forrest Ia requires urgent endoscopic hemostasis combining injection therapy (dilute adrenaline 1:10,000) with a mechanical method (hemoclip or heater probe). High-dose IV PPI (80mg bolus then 8 mg/hr infusion) is given before and after endoscopy. Failure of endoscopic hemostasis (Forrest Ia) requires interventional radiology or surgery.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.