Sakitamiwa Classification Hot! [RECOMMENDED × 2025]

Since its development, the Sakita-Miwa classification has become a valuable tool for endoscopists worldwide. Its primary applications include:

The is the global clinical standard for staging gastric and peptic ulcers. Developed in 1971 by Japanese gastroenterologists Sakita and Miwa, this six-stage endoscopic framework organizes the life cycle of an ulcer into three overarching macro-stages: Active (A) , Healing (H) , and Scarring (S) .

The white coating has completely disappeared. The ulcer base is fully covered by new epithelium, but the area remains markedly red due to new capillary growth. S2 (Scar-2 or White Scar):

: Edema decreases, the ulcer margin becomes clear, and small amounts of regenerating epithelium appear at the edges. Healing Stage (H1 & H2) H1 (Healing-1)

: The redness fades, and the area becomes a white scar as the mucosa fully matures. Clinical Importance Healing Assessment sakitamiwa classification

The Sakita-Miwa system is highly regarded for its precision. It divides the healing process into six distinct categories: 1. Active Stage (A)

to ensure they are progressing safely toward the scarring stage. Comparison : While the Sakita-Miwa system tracks healing, the Forrest Classification

Since its introduction in 1970, the Sakita-Miwa classification has become a cornerstone of gastrointestinal endoscopy, providing a practical and objective method for tracking ulcer healing. Its strength lies in its simplicity: by observing a few key characteristics—the presence of edema, the appearance of regenerating epithelium, the extent of white coating, and the nature of scar tissue—an endoscopist can accurately determine the ulcer's stage. This reliable framework is essential for clinical decision-making, from selecting appropriate therapies to designing rigorous clinical trials. Ultimately, the Sakita-Miwa classification ensures that clinicians worldwide can speak a common language when managing one of the most common gastrointestinal conditions, leading to more effective and consistent patient care.

The Active Stage represents the acute phase of a peptic or iatrogenic ulcer. The white coating has completely disappeared

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.

: Over a few weeks to months, the excess blood vessels regress. The redness fades completely, leaving behind a pale, white, or translucent fibrous scar. At stage S2, the ulcer is officially classified as endoscopically cured . Quantitative Scoring in Clinical Research

The Healing Stage marks the body's successful structural defense and repair response.

The is a widely used system in gastroenterology for staging the progression and healing of gastric and duodenal ulcers . First described by Sakita and Miwa, this classification helps clinicians determine whether an ulcer is in an active, healing, or scarring phase based on its endoscopic appearance. The Six Stages of Sakita-Miwa Classification Healing Stage (H1 & H2) H1 (Healing-1) :

infection or NSAID use to prevent a return to the "A" stage. Conclusion

By analyzing the macroscopic characteristics of a gastric or duodenal ulcer—such as the presence of a white slough coating, mucosal edema, margins, and regenerative epithelium—clinicians can objectively determine whether an ulcer is expanding, healing, or fully scarred. Today, it serves as an indispensable tool in both routine clinical practice and global pharmacological trials to measure the efficacy of acid-suppressing medications. The Three Main Stages and Six Substages

It helps detect endoscopic findings like compound ulcers or those associated with other conditions, such as superior mesenteric artery syndrome.

The active phase denotes the acute development of the ulcer, characterized by a distinct slough or sloughing layer covering the ulcer base.