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):
Proposed by Sakita and Miwa, this classification system breaks down the ulcer life cycle into distinct stages based on endoscopic appearance. It is designed to track the morphological changes of the ulcer crater over time. The primary stages include: The acute phase of the ulcer. Healing (H1, H2): The phase where regeneration begins.
The white coating becomes thinner, and regenerating epithelium extends into the ulcer base. The diameter of the defect typically reduces to about one-half to two-thirds of its original size in the A1 stage.
This represents the acute phase of mucosal injury where the ulcer crater is fully formed, necrotic, and susceptible to complications like hemorrhage.
: This is the acute phase of ulceration. Endoscopically, the ulcer base is deep and heavily coated with a thick, yellowish-white slough or exudate (white plaque). The surrounding mucosal margins are prominently swollen, elevated, and erythematous due to severe edema. Active bleeding or exposed, vulnerable blood vessels may sometimes be observed at this point. sakitamiwa classification
infection or NSAID use to prevent a return to the "A" stage. Conclusion
The ulcer has a white, deep base with sharp, surrounding inflammation.
The healing phase marks the transition from tissue destruction to active physiological repair. During this cycle, the human body actively reduces the surface area of the injury through epithelial cell migration.
The classification divides the natural history of a peptic ulcer into three distinct chronological phases: . These three phases are then further broken down into two stages each, creating a six-stage system: A1, A2, H1, H2, S1, and S2. A thin layer of regenerating epithelium (appearing as
The ulcer is deep with a distinct white coating (exudate) and a surrounding edematous, inflamed border.
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: 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.
In the field of gastroenterology, accurately assessing the stages of peptic ulcer healing is crucial for determining treatment efficacy and patient prognosis. While various systems exist to describe ulcers, the —often referred to simply as the Sakita-Miwa system—stands as a cornerstone in endoscopic diagnosis, particularly in East Asian clinical practice. It is designed to track the morphological changes
The Scar Stage indicates that the ulcer has closed, and the area is undergoing tissue remodeling. S1cap S sub 1
: 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 white coating thins, and regenerating epithelium extends into the ulcer base. The ulcer crater is still visible but smaller. H2 (Healing-2)