Sakitamiwa Classification Updated

[ Active Stage ] ----------> [ Healing Stage ] ----------> [ Scarring Stage ] ├── A1: Acute Slough ├── H1: Mucosal Bridging ├── S1: Red Scar └── A2: Defined Margins └── H2: Converging Folds └── S2: White Scar 1. The Active Stage (A-Stage)

Over time, the redness fades as the capillaries decrease, and the area becomes a pale, "white scar" that eventually blends with the surrounding normal mucosa. Summary Table Key Endoscopic Feature Active (A) A1 Thick slough, significant edema, no regeneration A2 Clearer margins, reduced edema, initial regeneration Healing (H) H1 Thin slough, defect reduced by ~50%, more regeneration H2 Minimal slough, defect mostly covered by new tissue Scarring (S) S1 Red scar; no slough; complete epithelial coverage S2 White scar; pale appearance; fully healed

: The ulcer becomes remarkably small and shallow. The white exudate coating is reduced to a tiny central speck or a very thin film. The surrounding regenerative epithelium covers the vast majority of the previous defect, and mucosal folds clearly converge directly toward the healing center. 3. The Scarring Stage (Stage S)

In clinical research, these stages are sometimes assigned scores to quantify healing progress: : 5–6 points (most active) : 4–5 points : 3–4 points : 2–3 points : 1–2 points : 0–1 points (fully healed)

The edema at the ulcer margin begins to subside, and the "lip-like sign" is less prominent. The ulcer base remains covered with slough. 2. Healing Stage (Stage H)

Over several months, the redness fades, and the area becomes pale or white, matching the surrounding mucosa. This is known as a "white scar". Clinical Significance Clinicians use this classification to: sakitamiwa classification

: Ulcers identified in the A1 or A2 stages pose a much higher risk for acute upper gastrointestinal bleeding compared to those in the healing or scarring stages.

: The thick necrotic coating becomes noticeably thinner, and a small layer of regenerating epithelium begins to creep inward from the edges. The slope between the surrounding stomach wall and the ulcer bed becomes flatter, and the overall diameter of the crater shrinks significantly.

The Sakita-Miwa system provides a standardized language that ensures consistent care, regardless of the treating physician. By providing a clear, visual framework (

Despite its utility, the Sakitamiwa Classification is not without critics. Key limitations include:

Beyond the Biomedical: An Ethnomedical Analysis of 'Sakitamiwa' Classification and its Socio-Cultural Determinants [ Active Stage ] ----------> [ Healing Stage

Primarily used in Western practice, the Forrest system is geared toward assessing the risk of re-bleeding from an ulcer (e.g., active bleeding vs. clean base), rather than the healing stage.

The is a globally recognized endoscopic staging system used in gastroenterology to assess the healing progression and chronological activity of peptic ulcers . Developed by Japanese researchers Sakita and Miwa, this classification system provides a highly structured framework that breaks down the lifecycle of gastric and duodenal mucosal lesions into three primary phases: Active (A), Healing (H), and Scarring (S) . Each of these phases is further bifurcated into two sub-stages (1 and 2), creating a comprehensive six-stage clinical scale that guides therapeutic interventions, tracks mucosal recovery, and standardizes scientific research.

The Sakita-Miwa Classification: A Comprehensive Guide to Endoscopic Ulcer Healing

While the Sakita-Miwa classification is the most widely accepted endoscopic staging system, it is sometimes helpful to compare it with other schemes that a clinician might encounter.

: The healing accelerates. The central white patch shrinks significantly, turning into a tiny island surrounded by a dominant, concentric ring of fresh red tissue. 3. The Scarring Stage (Stage S) The white exudate coating is reduced to a

: The necrotic slough covering the ulcer base drastically reduces in surface area. Regenerative epithelium begins migrating inward from the ulcer margins. Blood vessels become visible near the edge, delivering crucial oxygenation for granulation tissue development.

Regenerating epithelium covers most of the ulcer base, leaving only a tiny amount of slough in the center . S1

At this point, the ulcer is considered "endoscopically cured" because the mucosal defect has vanished.

This classification is a critical tool in clinical trials to evaluate the efficacy of acid-suppressing drugs like Proton Pump Inhibitors (PPIs) and Potassium-Competitive Acid Blockers (P-CABs) .