Upper gastrointestinal bleeding: forrest classification and rebleeding in patients with peptic ulcer disease at a teaching hospital in southwest Nigeria

Abstract

Background and Aim: Upper gastrointestinal bleeding (UGIB) is a common clinical emergency. In about 50- 70% of cases, peptic ulcer is the aetiology. Scoring systems commonly used to stratify patients with UGIB are Rockall, Blatchford and Forrest grading system. The aim of this study was to stratify patients presenting with peptic ulcer bleeding using Forrest classification and assess rebleeding rate.

Methodology: This was a descriptive study of 86 patients with bleeding peptic ulcer disease. After adequate resuscitation with fluids and blood, all the patients had upper gastrointestinal endoscopy according to protocol. At endoscopy, ulcers were graded according to Forrest classification.

Results: The patients comprised 63 (73.3%) males and 23 (26.7%) females. Mean age was 55.9±18.5 years. Frequency of symptoms of UGIB was: 4 (4.7%) patients presented with haematemesis alone, 34 (39.5%) presented with melaena alone, while 48 (55.8%) had both haematemesis and melaena. The ulcers were located in the duodenum in 47 (54.7%) patients. At endoscopy, the Forrest gradings were class III, IIC and IIA in 59 (68.6%), 16 (18.6%) and 6 (7.0%) respectively, class IA was not observed. Rebleeding was observed in 4 (4.7%) patients.

Conclusion: In our practice, most of our patients with peptic ulcer bleeding were low-risk based on Forrest classification and the rebleeding rate was also low. The use of intravenous PPI on all the patients at admission could have been of advantage.

Keywords: Peptic Ulcer Bleeding, Forrest Classification, Rebleeding, Southwest Nigeria