The ulcer remains active, but the surrounding swelling begins to decrease, and the edges of the ulcer become more defined. ClinicalTrials.gov 2. Healing Stage (H)
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The Sakita-Miwa classification is a widely recognized endoscopic system used to stage the life cycle and healing process of peptic ulcers . It divides the ulcer's progression into three main stages—Active, Healing, and Scarring—each containing two sub-stages . Key Endoscopic Characteristics Active (A) A1 sakitamiwa classification
: The dense white slough coating on the floor becomes noticeably thin. Regenerating epithelium begins migrating from the margins, covering less than 50% of the original ulcer base. Converging mucosal folds can now be clearly seen traveling directly toward the edge of the ulcer crater.
The classification divides the ulcer healing process into three main stages (A, H, S), which are further subdivided based on the morphological appearance of the ulcer: The ulcer remains active, but the surrounding swelling
: The open mucosal break has completely disappeared, replaced entirely by a fresh layer of regenerated epithelium. Because this new tissue is highly vascularized and packed with newly formed capillaries, the area appears as a bright red patch contrasting against the normal surrounding mucosa.
Modern gastroenterologists heavily rely on this scale to standardize diagnostic language, gauge the efficacy of acid-suppressing therapeutics, and manage post-operative healing after specialized procedures like Endoscopic Submucosal Dissection (ESD). The Six Stages of Ulcer Progression Whether used as a tool for spiritual growth,
The Sakitamiwa classification has been applied in various contexts, including:
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.
A regenerating epithelium begins to form at the edges, and the white coating at the base starts to thin and shrink.
The ulcer base is covered with a thick white slough. The surrounding mucosa is intensely swollen (edematous) and red. No regenerative epithelium (new skin) is visible. A2 (Active-2):