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MELD-NaAssesses the severity of chronic liver diseaseChild-Pugh ScoreAssesses the prognosis of chronic liver disease, mainly cirrhosisFIB-4 IndexLiver fibrosis scoring indexAPRIAST to platelet ratio — liver fibrosisMaddrey's DFAlcoholic hepatitis severityGlasgow-BlatchfordUpper GI bleed risk stratificationGAHSGlasgow alcoholic hepatitis scoreMontreal IBDIBD classification — CD & UCMayo ScoreUlcerative colitis activityBISAP ScoreBedside index for severity of pancreatitisCLIF-SOFAOrgan failure scoring in cirrhosisAlcohol ContentStandard drinks & alcohol grams calculatorAARC-ACLFAcute-on-chronic liver failure gradePELD / CR ScorePediatric end-stage liver diseaseHarvey-BradshawCrohn's disease activity indexCTSICT severity index — pancreatitisRockall ScoreGI bleed rebleeding & mortality riskCAGEAlcohol use disorder screening (4 questions)MELD 3.0Updated MELD — sex-inclusive formulaAUDIT ScoreAlcohol use disorders identification testVOCAL-Penn ScorePost-operative mortality risk in cirrhosis surgery

Liver & Cirrhosis

17
ALBI GradeAlbumin-bilirubin liver function grade in HCCUKELD ScoreUK model for end-stage liver diseaseMELD-XIMELD excluding INR — for anticoagulated patientsWest Haven CriteriaHepatic encephalopathy gradingMilan CriteriaLiver transplant eligibility in hepatocellular carcinomaLI-RADS v2018 (CT/MRI)Liver observation category from size, APHE and major featuresBCLC StagingHepatocellular carcinoma stage and treatment allocationSimplified AIH CriteriaSimplified criteria for autoimmune hepatitisRevised Original AIH ScoreIAIHG 1999 comprehensive autoimmune hepatitis scoreSAAGSerum-ascites albumin gradient — cause of ascitesR FactorHepatocellular vs cholestatic pattern in liver injuryCLIF-C ACLFMortality prediction in acute-on-chronic liver failureKing's College CriteriaTransplant criteria in acute liver failureGALAD ScoreHCC detection from gender, age, AFP-L3, AFP and DCPMetroticket 2.0AFP-adjusted up-to-seven for HCC transplant eligibilityRUCAMCausality in drug- and herb-induced liver injuryBaveno VII CriteriacACLD, CSPH and sparing screening endoscopy

Fibrosis & MASLD

8
NAFLD Fibrosis ScoreAdvanced fibrosis probability in MASLD/NAFLDBARD ScoreBMI, AST/ALT ratio, diabetes — MASLD fibrosisFatty Liver IndexPredicts hepatic steatosis from routine labsFibrotic NASH Index (FNI)At-risk NASH probability from AST, HbA1c and HDLNAFLD Activity Score (NAS)Histologic activity grade — steatosis, inflammation, ballooningMEFIB IndexMRE + FIB-4 rule for significant fibrosis (≥F2) in MASLDFAST ScoreFibroScan-AST — at-risk NASH from LSM, CAP and ASTSAFE ScoreSteatosis-Associated Fibrosis Estimator for MASLD in primary care

Pancreas & Biliary

8
Ranson's CriteriaAcute pancreatitis severity at 48 hoursGlasgow-Imrie CriteriaAcute pancreatitis severity — the PANCREAS criteriaHAPSHarmless acute pancreatitis scoreTokyo Guidelines — CholangitisTG18 diagnosis and severity grade for acute cholangitisTokyo Guidelines — CholecystitisTG18 diagnosis and severity grade for acute cholecystitisBiliary Pain (Rome IV)Rome IV — defining biliary-type pain before interventionFunctional Pancreatic SODRome IV — pancreatic sphincter of Oddi disorderRevised Atlanta ClassificationAcute pancreatitis severity — mild, moderately severe, severe

IBD

9
Truelove & Witts CriteriaAcute severe ulcerative colitis — admission decisionUCEISUlcerative colitis endoscopic index of severitySCCAISimple clinical colitis activity index — symptoms onlyCDAICrohn's disease activity index — the trial standardSES-CDEndoscopic severity in Crohn's diseasePUCAIPaediatric ulcerative colitis activity indexTravis (Oxford) CriteriaDay 3 colectomy risk in acute severe ulcerative colitisHo IndexDay 3 steroid failure risk in acute severe ulcerative colitisRutgeerts ScorePostoperative Crohn's recurrence at ileocolonoscopy

GI Bleeding

7
EVendo ScorePredicts oesophageal varices needing treatmentForrest ClassificationPeptic ulcer bleeding — rebleeding risk at endoscopyAIMS65 ScoreUpper GI bleed mortality — five bedside criteriaOakland ScoreSafe-discharge risk for acute lower GI bleedingABC ScoreAge, blood tests, comorbidities — GI bleed mortalitySarin ClassificationEndoscopic classification of gastric varicesEGUS (Gastric Ulcer)Malignancy risk in a gastric ulcer, and who needs repeat endoscopy

Alcohol

2
ABIC ScoreAge, bilirubin, INR, creatinine — alcoholic hepatitisLille ModelSteroid response at day 7 in alcoholic hepatitis

Upper GI

4
Chicago Classification v4.0Oesophageal motility pattern from high-resolution manometryLA Classification (Oesophagitis)Los Angeles grade A–D for erosive oesophagitisPrague C & M CriteriaCircumferential and maximal extent of Barrett's oesophagusEREFS (Eosinophilic Oesophagitis)Endoscopic reference score — oedema, rings, exudates, furrows, stricture

Colorectal

3
Boston Bowel Prep ScaleColonoscopy preparation adequacy by segmentStool Osmotic GapOsmotic vs secretory diarrhoea from stool electrolytesATLAS Score (C. difficile)Predicted response to therapy in Clostridioides difficile infection

Functional GI

37
Bristol Stool ScaleStool form types 1–7 and colonic transitRome IV Criteria for IBSIrritable bowel syndrome diagnosis and subtypeFunctional ConstipationRome IV — two of six items, IBS excludedOpioid-Induced ConstipationRome IV — constipation tied to opioid therapyFunctional DiarrhoeaRome IV — loose stools without predominant painFunctional Bloating / DistensionRome IV — bloating without other bowel disorder criteriaUnspecified Functional Bowel DisorderRome IV — bowel symptoms fitting no other categoryCentrally Mediated Abdominal Pain (CAPS)Rome IV — continuous pain unrelated to gut eventsNarcotic Bowel SyndromeRome IV — opioid-induced hyperalgesia of the gutFaecal Incontinence (Rome IV)Rome IV — the criteria, and why nobody is askedFunctional Anorectal PainLevator ani, unspecified pain and proctalgia fugaxFunctional Defecation DisordersRome IV — dyssynergia and inadequate propulsionInfant RegurgitationRome IV — the happy spitter, and the alarm features that rule it outInfant ColicRome IV — recurrent unexplained crying in a well infant under 5 monthsInfant DyscheziaRome IV — straining before a soft stool, and why not to intervenePaediatric Functional ConstipationRome IV — two of six over one month, with overflow soiling as a criterionToddler's DiarrhoeaRome IV functional diarrhoea of childhood — painless, thriving childPaediatric Cyclic Vomiting SyndromeRome IV — both age bands, with different criteria for eachPaediatric Rumination SyndromeRome IV — infant and child/adolescent criteriaFunctional Nausea & Vomiting (Children)Rome IV — two separate disorders that can be met togetherAerophagiaRome IV — distension that increases through the dayPaediatric Functional DyspepsiaRome IV — four times a month, with PDS and EPS subtypingPaediatric Irritable Bowel SyndromeRome IV — plus the constipation clause clinicians missAbdominal MigraineRome IV — stereotypical incapacitating episodes weeks apartFunctional Abdominal Pain — NOSRome IV — the residual category, reached after the other threeNonretentive Faecal IncontinenceRome IV — soiling without retention, where laxatives make it worseFunctional DyspepsiaRome IV — with PDS and EPS subtypingRumination SyndromeRome IV — effortless regurgitation without retchingCyclic Vomiting SyndromeRome IV — stereotypical episodic vomitingCannabinoid HyperemesisRome IV — CVS pattern relieved by cannabis cessationChronic Nausea & VomitingRome IV — chronic nausea and vomiting syndromeBelching DisordersRome IV — supragastric vs gastric belchingFunctional HeartburnRome IV — heartburn with normal acid exposureReflux HypersensitivityRome IV — normal acid exposure, positive symptom associationFunctional Chest PainRome IV — non-cardiac, non-reflux chest painGlobusRome IV — painless lump-in-throat sensationFunctional DysphagiaRome IV — dysphagia with normal endoscopy and manometry
  1. Calculators
  2. /
  3. EGUS (Gastric Ulcer)
GI Bleeding

EGUS (Gastric Ulcer)

Malignancy risk in a gastric ulcer, and who needs repeat endoscopy

Bands are under 68 (0 points), 68-79 (1) and 80 or over (2).

The heaviest variable. Bands are under 1.25 cm (0 points), 1.25-2.99 cm (2) and 3.00 cm or more (3) — note there is no 1-point band.

Non-antral location scores 1. Antral ulcers were significantly less likely to be malignant in the derivation cohort.

Answers one question: how likely is this gastric ulcer to be malignant. Its purpose is to identify who can safely avoid a repeat endoscopy for healing — it is a negative-predictive-value instrument, and its reassurance only holds alongside benign macroscopic appearances and adequate biopsies.

When to use
Use it after an index endoscopy has found a gastric ulcer, when deciding whether that patient needs to come back for a healing check. That is the specific question it was built for. It is not a bleeding risk score, it does not predict mortality, and it is not a substitute for the endoscopist's macroscopic impression at the index procedure.
Why use it
Because universal repeat endoscopy for gastric ulcer healing has been standard practice for decades on the reasoning that a small number of gastric cancers present as apparently benign ulcers, and nobody wants to miss one. The Edinburgh work tested that reasoning against its own data and found something striking: no cancer was found on follow-up endoscopy of a benign-appearing ulcer with negative biopsies, and every cancer diagnosed at a later endoscopy had already been macroscopically suspicious at the first. The score exists to make that finding usable — to identify prospectively the patients for whom a repeat procedure is very unlikely to change anything, and thereby spare them an unnecessary endoscopy while keeping the ones where suspicion is genuinely warranted.
Formula, evidence and interpretation

About the Edinburgh Gastric Ulcer Score (EGUS)

Three variables scored 0 to 6. Age contributes 0 under 68, 1 from 68 to 79, and 2 at 80 or over. Ulcer size contributes 0 below 1.25 cm, 2 from 1.25 to 2.99 cm, and 3 at 3.00 cm or more — note there is no 1-point size band, and size is the heaviest variable. Non-antral location adds 1. A score of 3 or more identified 78% of malignant ulcers in derivation and 84% in external validation; below 3 the negative predictive value was 97.4% and 98.6% respectively. The score answers whether a gastric ulcer needs a repeat endoscopy to confirm healing — and its reassurance holds only alongside benign macroscopic appearances and at least six negative biopsies.

On this page

  • Formula
  • Interpreting the result
  • Inputs
  • What it returns
  • How it is calculated
  • Facts & figures
  • Evidence
  • How it compares
  • Pearls & pitfalls
  • Critical actions
  • Why it exists
  • About the creator
  • Limitations
  • If you are the patient
  • FAQ
  • Related calculators
  • References

Formula

Age under 68 -> 0 68 to 79 -> 1 80 or over -> 2 Ulcer size under 1.25 cm -> 0 1.25-2.99 cm -> 2 3.00 cm or more -> 3 Location antral -> 0 non-antral -> 1 Total 0-6. Score >= 3 = higher risk of malignancy. NPV below 3: 97.4% (derivation), 98.6% (external validation) AUC: 0.868 (derivation), 0.862 (validation)
Ulcer size
Carries up to 3 points, more than any other item, and a 3 cm ulcer therefore reaches the threshold with no other risk factor at all.
The missing 1-point size band
Size goes 0, then 2, then 3. The jump reflects how sharply malignancy risk rose above 1.25 cm in the derivation data rather than any tidying of the scale.
Non-antral location
Only 1 point, but it is the item most likely to be recorded inconsistently, since ulcer location descriptions vary between endoscopists.
  • Derived in 778 patients in NHS Lothian with an index endoscopy and gastric ulcer between 2014 and 2018, of whom 8.6% were diagnosed with cancer.
  • The score is a negative-predictive-value instrument — its purpose is safe reassurance rather than case-finding.
  • It applies only alongside benign macroscopic appearances and at least six negative biopsies; all three conditions are required together.
  • Macroscopic suspicion at the index endoscopy overrides the score entirely.

Interpreting the result

A score below 3 means repeat endoscopy for healing may reasonably be omitted — but only when two other conditions are also satisfied: the ulcer looked macroscopically benign at the index procedure, and at least six biopsies were taken and were negative. All three requirements travel together, and the negative predictive value quoted does not apply if any one is missing. In practice the biopsy count is the most common weak point, so confirm it explicitly rather than assuming it. A score of 3 or more warrants follow-up endoscopy with repeat biopsies. Look at what is driving it: size alone reaches the threshold at 3 cm, and a large ulcer in an otherwise low-risk patient is a different clinical picture from an accumulation of modest risk across all three items, even though the totals match. Most importantly, the score never overrides the endoscopist. In the derivation cohort every cancer found at a subsequent endoscopy had already been macroscopically suspicious at the index procedure — so a suspicious-looking ulcer is followed up regardless of what the arithmetic says. Alongside all of this, treat the ulcer: eradicate Helicobacter pylori where present and review NSAID and aspirin use, since the score says nothing about why the ulcer is there.

ScoreBandWhat it meansAction
0–2Lower risk of malignancyNegative predictive value 97.4% in derivation, 98.6% in external validationRepeat endoscopy may be omitted — but only with benign appearances AND at least six negative biopsies
3–6Higher risk of malignancyCaptured 78% of malignant ulcers in derivation and 84% in validationFollow-up endoscopy with repeat biopsies

What the EGUS (Gastric Ulcer) needs (3 inputs)

Age
Under 68 scores 0, 68 to 79 scores 1, and 80 or over scores 2. The bands are unusual numbers because they came out of the regression rather than from convention.
Ulcer size
The heaviest variable: under 1.25 cm scores 0, 1.25 to 2.99 cm scores 2, and 3.00 cm or more scores 3. There is no 1-point band — the scale jumps from 0 straight to 2.
Ulcer location
Non-antral location scores 1, antral scores 0. Antral ulcers were significantly less likely to be malignant in the derivation cohort.

What it returns

Total score, 0 to 6
A score of 3 or more is the published threshold for higher malignancy risk.
The item breakdown
Shown because a score driven entirely by size behaves differently from one accumulated across all three items — a 3 cm ulcer reaches the threshold on its own.

How it is calculated

The three variables are the ones that survived logistic regression against a diagnosis of cancer, and each is a proxy for something reasonably intuitive. Size matters most because a larger ulcer represents more tissue destruction than acid and pepsin readily explain, and because malignant ulceration tends to present later and therefore larger — which is why it carries the heaviest weight and why the scale jumps rather than rising smoothly. Age is a straightforward proxy for cumulative cancer risk and for the declining probability that a simple peptic cause is the whole story. Location matters because the antrum is where ordinary peptic disease concentrates, so an ulcer elsewhere in the stomach is less well explained by the usual mechanism. What the score does not contain is as informative as what it does: there is no Helicobacter status, no NSAID history, no symptom variable. Those predict whether an ulcer is peptic in origin, which is a different question from whether this particular one is malignant, and they did not add discrimination once size, age and location were in the model.

Facts & figures

The scoring table
VariableCategoryPoints
AgeUnder 680
68–791
80 or over2
Ulcer sizeUnder 1.25 cm0
1.25–2.99 cm2
3.00 cm or more3
LocationAntral0
Non-antral1

Maximum 6. Note the size scale runs 0, 2, 3 — there is no 1-point band, and 3 cm reaches the threshold on its own.

The three conditions that must hold together for reassurance
ConditionWhy it matters
Score below 3The statistical component — NPV 97.4% to 98.6%
Macroscopically benign at index endoscopyEvery cancer found on later endoscopy in the derivation cohort had been macroscopically suspicious at the first
At least six biopsies, all negativeThe most commonly missing element; an inadequately biopsied ulcer is not a low-risk ulcer

The published reassurance applies to the combination, not to the score in isolation.

Evidence

Derivation and validation — EGAR Collaborative, Edinburgh

2021

All patients in NHS Lothian with an index endoscopy and a diagnosis of gastric ulcer between January 2014 and December 2018 — 778 patients, of whom 8.6% were diagnosed with cancer. Logistic regression identified age, ulcer size and non-antral location as significantly associated with malignancy.

AUC 0.868 in derivation. A score of 3 or more captured 78.0% of malignant ulcers while only 15.8% of benign ulcers reached it, giving a negative predictive value of 97.4%.

External validation

2021

An independent cohort reported in the same publication.

AUC 0.862 with a negative predictive value of 98.6%; 84.0% of malignant ulcers scored 3 or more.

Context — the aetiology the score does not address

2022

The Maastricht VI/Florence consensus on the management of Helicobacter pylori infection.

Sets out eradication as standard care where H. pylori is present. The EGUS score contains no aetiological variable, so treating the cause remains a separate obligation irrespective of the score.

How it compares

EGUS (Gastric Ulcer) vs Forrest classification

The same lesion, entirely different questions — is it bleeding, versus is it cancer.

Forrest grades the stigmata of recent haemorrhage in a peptic ulcer and predicts rebleeding, guiding whether endoscopic therapy is needed now. EGUS ignores bleeding completely and asks whether the ulcer is malignant, guiding whether a repeat endoscopy is needed later. They are applied at the same procedure to the same ulcer and answer questions on entirely different timescales. Confusing them is easy because both are gastric ulcer scores, and doing so would be consequential in either direction.

Open the Forrest classification calculator →

EGUS (Gastric Ulcer) vs Glasgow-Blatchford score

Pre-endoscopy triage against post-endoscopy follow-up planning — opposite ends of the same admission.

Glasgow-Blatchford is calculated before endoscopy from blood results and observations, and identifies patients at such low risk that they may not need admission at all. EGUS is calculated after endoscopy, from what was seen, and decides whether the patient returns weeks later. Neither informs the other, but both come up in the management of a patient presenting with a gastric ulcer, and the sequence is worth keeping straight: Blatchford before, Forrest during, EGUS after.

Open the Glasgow-Blatchford score calculator →

EGUS (Gastric Ulcer) vs Montreal classification

Both are descriptive endoscopic classifications rather than risk models, but only EGUS carries a probability.

Montreal classifies inflammatory bowel disease phenotype by location and behaviour, producing a label that travels with the patient. EGUS produces a number attached to a specific lesion at a specific moment, and that number carries a validated negative predictive value. The comparison is worth drawing because it locates what EGUS actually is: not a taxonomy of gastric ulcers but a decision instrument for one narrow decision, and it should not be recorded as a permanent characteristic of the patient.

Open the Montreal classification calculator →Brindle WM, Grant RK, Smith M, et al; EGAR Collaborative. Risk stratifying gastric ulcers: development and validation of a scoring system. Frontline Gastroenterol. 2021;13(2):111-118.

Pearls & pitfalls

  • This predicts malignancy, not bleeding and not mortality. It is unrelated to the Forrest classification or the bleeding risk scores despite also concerning gastric ulcers.
  • The reassurance requires three things together: score below 3, benign macroscopic appearance, and at least six negative biopsies.
  • Confirm the biopsy count explicitly — it is the condition most often missing, and an inadequately biopsied ulcer is not a low-risk ulcer.
  • Macroscopic suspicion at the index endoscopy overrides the score entirely.
  • Size is the heaviest variable and a 3 cm ulcer reaches the threshold with nothing else present.
  • There is no 1-point size band; the scale runs 0, 2, 3.
  • The age bands are 68 and 80, not the round numbers people tend to assume.
  • The score contains no Helicobacter status and no NSAID history — treating the cause is a separate obligation.
  • Location recording varies between endoscopists, which makes the 1-point location item the least reproducible.
  • Derived and validated in Scottish cohorts, where gastric cancer incidence is lower than in East Asian populations.

Critical actions

  • Record the ulcer size in centimetres at the index endoscopy — the score cannot be applied without it.
  • Record the location explicitly as antral or non-antral.
  • Take at least six biopsies from the ulcer at the index procedure.
  • Document the macroscopic impression separately from the score.
  • Test for Helicobacter pylori and eradicate where positive.
  • Review NSAID, aspirin and anticoagulant use.
  • Arrange follow-up endoscopy for a score of 3 or more, or for any macroscopic suspicion.
  • Where follow-up is omitted, record why — score, appearance and biopsy count — so the decision is auditable.

Why this score exists

The most quietly radical thing in this paper is not the score at all — it is the observation that no cancer was found on follow-up endoscopy of a benign-appearing ulcer with negative biopsies, and that every cancer diagnosed at a later procedure had already looked suspicious at the first. That finding, if it holds, means the routine healing endoscopy was mostly detecting nothing, and had been performed for decades on the strength of a fear rather than a measured yield. The score is the mechanism for acting on that conclusion safely, and its design reflects exactly that purpose: it is tuned for negative predictive value, not for discrimination in the abstract. That is why the threshold sits where it does, catching a substantial majority of cancers at the cost of flagging some benign ulcers — in a rule-out instrument, a false positive costs one endoscopy while a false negative costs a missed cancer, and the asymmetry is entirely deliberate. It is also why the three conditions travel together. Quoting the negative predictive value for a score below 3 without the biopsy count and the macroscopic impression is not a shortcut; it is using a different instrument from the one that was validated.

About the creator

  • William M. Brindle

    First author; EGAR Collaborative, Edinburgh

    Led the derivation and validation of the score.

  • Rahul Kalla

    Co-author; consultant gastroenterologist, Edinburgh

    Contributed to the EGAR Collaborative analysis.

  • Gavin S. M. Masterton

    Senior author; EGAR Collaborative

    Supervised the study that questioned universal follow-up endoscopy for gastric ulcer healing.

Limitations

  • Derived and validated in Scottish cohorts, where gastric cancer incidence is substantially lower than in East Asian populations, so the negative predictive value may not transfer.
  • Only 66 cancers occurred in the derivation cohort, which is a small number of events for a three-variable model.
  • Ulcer size is measured by visual estimate at endoscopy, with well-recognised interobserver variation around the 1.25 cm and 3 cm boundaries.
  • Antral versus non-antral location is recorded inconsistently between endoscopists.
  • The score contains no aetiological variable — no Helicobacter status, no NSAID history — so it says nothing about why the ulcer formed.
  • Its reassurance is conditional on biopsy adequacy, which the score itself cannot verify.
  • It was built to inform a single decision about follow-up endoscopy and has not been validated for any other purpose.
  • External validation came from the same publication rather than an independent later study.

If you are the patient

If a camera test has found an ulcer in your stomach, one question the team has to answer is whether it might be cancer rather than an ordinary ulcer. Most stomach ulcers are not cancer, but a small number are, which is why samples are always taken at the time and why people have traditionally been brought back for a second camera test a few weeks later to check the ulcer has healed. This score helps work out who genuinely needs that second test. It uses three things: your age, how big the ulcer is, and whereabouts in the stomach it sits. Size matters most — a large ulcer raises the score more than anything else. A low score means the chance of the ulcer being cancer is very small, and a repeat camera test may not be needed. Importantly, that reassurance only applies if two other things were also true at the first test: the ulcer looked ordinary to the endoscopist, and at least six samples were taken and all came back clear. If any of those is missing, the score alone is not enough. A higher score means it is worth coming back for another look and more samples. One thing worth knowing: if the doctor doing the first test thought the ulcer looked suspicious, you will be brought back regardless of the score — their impression counts for more than the arithmetic. Separately from all this, the cause of the ulcer needs treating. That usually means testing for a bacterium called Helicobacter pylori and clearing it if present, and reviewing any anti-inflammatory painkillers you take.

Frequently asked questions

What is the Edinburgh Gastric Ulcer Score?#

A three-variable score estimating the likelihood that a gastric ulcer is malignant, built to decide who needs a repeat endoscopy to confirm healing. Age scores 0, 1 or 2; ulcer size scores 0, 2 or 3; non-antral location scores 1. The total runs 0 to 6, and 3 or more indicates higher risk.

What does a low score mean?#

That repeat endoscopy may reasonably be omitted — but only alongside two other conditions: the ulcer looked macroscopically benign at the index procedure, and at least six biopsies were taken and were negative. The published negative predictive value, 97.4% in derivation and 98.6% in validation, applies to that combination and not to the score by itself.

Why is there no 1-point band for ulcer size?#

Because the risk did not rise smoothly. Size scores 0 below 1.25 cm, then jumps straight to 2 from 1.25 to 2.99 cm, and 3 at 3.00 cm or more. The jump reflects how sharply malignancy risk increased above 1.25 cm in the derivation data rather than any attempt to make the scale tidy.

Can a large ulcer reach the threshold on its own?#

Yes. An ulcer of 3 cm or more scores 3 by itself, which is the threshold, regardless of the patient's age or the ulcer's location. Size is the heaviest variable in the score, which is why the item breakdown is worth reading rather than only the total.

Does the score override the endoscopist's impression?#

Never, and the derivation data are unusually clear on this. Every cancer diagnosed at a subsequent endoscopy in that cohort had already been macroscopically suspicious at the index procedure. A suspicious-looking ulcer is followed up whatever the score says.

Is this a bleeding risk score?#

No, and the confusion is easy to fall into since it concerns gastric ulcers. EGUS predicts malignancy. Bleeding risk in a peptic ulcer is assessed by the Forrest classification at endoscopy and by scores such as Glasgow-Blatchford and Rockall around it. The sequence is Blatchford before, Forrest during, EGUS after.

Does the score tell you anything about the cause of the ulcer?#

Nothing at all. There is no Helicobacter pylori status and no NSAID history in the model — those predict whether an ulcer is peptic in origin, which is a different question from whether this one is malignant, and they added no discrimination once size, age and location were included. Testing for and eradicating H. pylori, and reviewing NSAID use, remain separate obligations.

Where might this score not apply?#

It was derived and validated in Scottish cohorts, where gastric cancer incidence is considerably lower than in East Asian populations. Since the score is a negative-predictive-value instrument, and negative predictive value depends on prevalence, its reassurance is the part most likely not to transfer to a higher-incidence setting.

Related calculators

  • Forrest Classification — Peptic ulcer bleeding — rebleeding risk at endoscopy
  • Glasgow-Blatchford — Upper GI bleed risk stratification
  • Rockall Score — GI bleed rebleeding & mortality risk
  • Montreal IBD — IBD classification — CD & UC
  • ATLAS Score (C. difficile) — Predicted response to therapy in Clostridioides difficile infection

References

Original / primary reference

  1. Brindle WM, Grant RK, Smith M, Suddaby M, Wallace A, Gillespie SL, et al; EGAR (Edinburgh GI Audit and Research) Collaborative. Risk stratifying gastric ulcers: development and validation of a scoring system. Frontline Gastroenterol. 2021;13(2):111-118.

Treating the underlying cause

  1. Malfertheiner P, Megraud F, Rokkas T, Gisbert JP, Liou JM, Schulz C, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022;71(9):1724-1762.

Related management of the bleeding ulcer

  1. Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol. 2021;116(5):899-917.
  2. Gralnek IM, Stanley AJ, Morris AJ, Camus M, Lau J, Lanas A, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): ESGE Guideline - Update 2021. Endoscopy. 2021;53(3):300-332.

Last updated August 1, 2026. Clinical knowledge base written and curated by GastroAGI Team from primary medical literature.

Written from primary literature and not yet independently clinically reviewed.

For use by qualified healthcare professionals. This calculator supports clinical judgement and does not replace it.