Sakitamiwa Classification _verified_ Jun 2026

Slough becomes thinner; edema at the margin begins to decrease; the ulcer base is clearly demarcated . H1

The Sakita-Miwa classification is more than just a descriptive list; it is a critical diagnostic guide. For instance, an ulcer in the

Provide a universal language for endoscopists to describe ulcer activity.

: The white coating thins, and regenerating epithelium extends into the ulcer base. The ulcer crater is still visible but smaller. H2 (Healing-2) sakitamiwa classification

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)

While the Sakita-Miwa system is the most widely used for peptic ulcer disease, other classification systems exist. It is important to distinguish it from these other tools:

The edema at the ulcer margin begins to subside, and the ulcer base appears cleaner. The white coating may begin to thin. 2. Healing Stage (H1 & H2) Slough becomes thinner; edema at the margin begins

: The ulcer becomes significantly smaller and shallower. The regenerative epithelium covers most of the ulcer base, leaving only a small amount of central white slough. 3. Scarring Stage (S)

The is a universally recognized medical framework used primarily by gastroenterologists to evaluate, stage, and monitor the healing lifecycle of gastric ulcers . Developed in Japan by researchers Sakita and Miwa, this staging system divides the progression of a peptic or gastric ulcer into six distinct phases nested within three major clinical periods: Active (A), Healing (H), and Scarring (S) .

: 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) : The white coating thins, and regenerating epithelium

| Stage | n (%) | 14-day mortality | Progression to higher stage | Likelihood of severe bleeding | |-------|-------|------------------|-----------------------------|-------------------------------| | 0 | 310 (25.8%) | 0.0% | 2.3% | 0% | | I | 487 (40.4%) | 1.2% | 8.7% | 0.4% | | II | 255 (21.2%) | 8.6% | 21.2% | 5.1% | | III | 112 (9.3%) | 41.1% | 33.0% | 38.4% | | IV | 40 (3.3%) | 72.5% | N/A | 67.5% |

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