TITLE:
Guideline-Directed Combination Endoscopic Therapy for Severe Forrest Ib Duodenal Ulcer Bleeding in a Young Adult: A Case Report and Literature Review
AUTHORS:
Yashar Tolentino Najiagdam
KEYWORDS:
Upper Gastrointestinal Bleeding, Duodenal Ulcer, Forrest Classification, Forrest Ib, Endoscopic Clipping, Epinephrine Injection, Combination Therapy, Non-Variceal Hemorrhage, Rebleeding Risk, ACG 2021, ESGE 2021
JOURNAL NAME:
Open Journal of Internal Medicine,
Vol.16 No.1,
March
20,
2026
ABSTRACT: Non-variceal upper gastrointestinal bleeding (NVUGIB) remains a major cause of emergency hospitalization and significant morbidity worldwide. Peptic ulcer disease is the most common etiology. Active ulcer bleeding classified as Forrest Ib (oozing hemorrhage) represents high-risk stigmata requiring urgent endoscopic therapy to reduce rebleeding and mortality. We report a 23-year-old patient presenting with melena and severe anemia (hemoglobin 6 g/dL). Urgent esophagogastroduodenoscopy revealed an actively oozing duodenal ulcer consistent with Forrest Ib classification. Endoscopic therapy consisted of diluted epinephrine injection followed by definitive mechanical hemoclip placement. Complete hemostasis was achieved without rebleeding. Hemoglobin improved to 13 g/dL following transfusion and stabilization. Management adhered to the 2021 ACG and 2021 ESGE guidelines recommending combination therapy for high-risk ulcer bleeding and discouraging epinephrine monotherapy.