Sakitamiwa Classification -

The Sakita-Miwa classification is a fundamental endoscopic tool used in gastroenterology to categorize the life cycle of a gastric ulcer. Established by Japanese researchers Sakita and Miwa, this system provides a standardized language for clinicians to describe whether an ulcer is in an active state, a healing state, or a scarring state. By breaking down the healing process into six distinct stages, it allows doctors to monitor patient progress, evaluate the effectiveness of treatments, and predict the risk of recurrence or complications. Structure of the Classification

The active phase marks the acute stage of the ulcer, where the lesion is at its most aggressive state.

The system is divided into three primary stages, each containing two sub-levels based on the visual appearance of the ulcer during an endoscopy: 1. The Active Stage (A) A1 (Active-1): sakitamiwa classification

indicates that while the ulcer is still active, the body has begun its healing response. The most notable change at this stage is a decrease in the surrounding edema , making the ulcer margins clearer and more distinct. What defines A2 is the endoscopic appearance of a slight amount of regenerating epithelium at the ulcer margin. Two characteristic features are often present: a thin red halo encircling the ulcer and a clear white slough circle .

While originally for gastric ulcers, the classification is also adapted to monitor ulcers in intestinal Behçet's disease. Sakita-Miwa vs. Other Classifications Structure of the Classification The active phase marks

Over time, the redness fades. The area turns into a pale, flat, or slightly depressed "white scar". Clinical Scoring System

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 The most notable change at this stage is

The ulcer crater is still visible, but the margins become sharper and the diameter of the defect shrinks to about half or two-thirds of the A1 stage. Regenerating epithelium (new skin) starts appearing at the edges.

This comprehensive article will explore the history and core principles of the Sakita-Miwa classification, provide a detailed breakdown of its six stages, and examine its wide-ranging clinical applications.

: The slough has nearly vanished, leaving only a tiny central island of white coating. The ulcer grows noticeably shallower, and the surrounding mucosa starts organizing into a converging, radial pattern of mucosal folds moving toward the healing center. 3. The Scarring Stage (S)

A thin layer of regenerating epithelium (appearing as a reddish or pale area) begins to creep in from the edges of the ulcer. The slough on the ulcer floor begins to thin and contract. H2 (Healing-2):