Sakitamiwa Classification - Link

[ Active Stage ] ----------> [ Healing Stage ] ----------> [ Scarring Stage ] ├── A1: Acute Slough ├── H1: Mucosal Bridging ├── S1: Red Scar └── A2: Defined Margins └── H2: Converging Folds └── S2: White Scar 1. The Active Stage (A-Stage)

A higher score indicates a more active ulcer, while a lower score represents a more healed state. Generally, an ulcer is considered clinically "healed" when it reaches the S1cap S sub 1 S2cap S sub 2 3. Clinical Applications

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

(Active 2): The ulcer shows signs of early healing, but the white-plaque coating remains significant. The surrounding edema begins to reduce, and the margins become slightly better defined. H-Stage (Healing Stage) sakitamiwa classification

Successful treatment is often defined as achieving S1 or S2 stages within a specific timeframe.

The ulcer floor is covered heavily by a thick, deep-seated layer of white or yellowish-gray exudate (necrotic slough). The surrounding mucosal margins are prominently edematous, hyperemic, and lack any signs of epithelial regeneration. Thrombi or exposed, pulsating blood vessels may be visibly projecting through the exudative base.

: The floor is completely covered by regenerating epithelium, and the white coating has disappeared. It appears as a "red scar" due to visible capillaries. S2 (White Scar) [ Active Stage ] ----------> [ Healing Stage

This stage represents the nadir of mucosal integrity. The body is actively dealing with local tissue destruction.

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) .

It helps determine if a drug (e.g., vonoprazan vs. rabeprazole) provides faster healing of post-Endoscopic Submucosal Dissection (ESD) ulcers. Clinical Applications infection or NSAID use to prevent

is the hallmark of an acute, active ulcer. The ulcer crater is typically deep and completely covered by a thick, shaggy layer of white or yellowish-white fibrin slough—the necrotic tissue at the base of the ulcer. This stage is characterized by significant inflammation of the surrounding area; the mucosa adjacent to the crater is markedly swollen, red, and edematous, which makes the ulcer’s margins look heaped up. Importantly, no visible regenerating epithelium (the new, healthy pink tissue) is seen at the edges.

The original 2021 system defined only Stages 0–IV. However, a small series of survivors (n=19) developed a chronic fatigue syndrome with persistent arthralgia and elevated serum IL-6 for >6 months. This has been proposed as . Diagnostic criteria require: documented acute SKTV infection, no alternative rheumatologic diagnosis, and a Fatigue Severity Score > 4. No specific treatment exists, but low-dose naltrexone is under trial.

: The thick necrotic coating becomes noticeably thinner, and a small layer of regenerating epithelium begins to creep inward from the edges. The slope between the surrounding stomach wall and the ulcer bed becomes flatter, and the overall diameter of the crater shrinks significantly.

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.