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Bleeding Gastric Ulcers

High resolution image: Ulcer with eroded vessel, indication a 40% risk of rebleeding.

Eroded vessel in a gastric ulcer

A finding like this indicate, that this ulcer has been bleeding, and that there is a high risk of rebleeding. In the middle of the ulcer an eroded blood vessel is seen.

Eroded vessel in a gastric ulcer

In this ulcer, the eroded vessel is in the margin of the ulcer

Gastric ulcer, that just has been bleeding

The black bottom of this gastric ulcer is caused of coagulated blood, indicating that this finding gives an excellent explanation to the patients gastrointestinal bleeding.

Small ulcer with an eroded vessel

A finding like this is associated with a significant risk of rebleeding

Ulcer with an eroded vessel

An ulcer like this with a visible artery in the middle of the ulcer could be treated with injection therapy, electrocoagulation or laser to diminish the risk of rebleeding.

Another example of ulcers with eroded vessels

Forrest classification of bleeding ulcers:

Click on an image to get a magnification!

Forrest Classification Peptic ulcer disease is the most common cause of upper gastrointestinal bleeding. The endoscopic finding can give valuable information about the risk of rebleeding after hospital admission. Endoscopic signs indicating risk of rebleeding were classified in 1974 by Forrest et al (Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet 1974;17:394-397). The classification is as follow:

Forrest class:
IA
IB
IIA
IIB
IIC
III

Type of lesion:
Arterial spurting bleeding
Arterial oozing bleeding
Visible vessel
Sentinel clot
Hematin covered flat spot
No stigmata of hemorrhage

Risk of rebleeding if untreated:
100%
55% (17 - 100%)
43% (8-81%)
22% (14 - 36%
10% (0 - 13%)
5% (0 - 10%)

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