The red scar turns white, indicating a mature scar (white scar stage). Clinical Application and Significance
The regenerating epithelium completely covers the ulcer floor, and the white coating has disappeared. The area appears markedly red due to the presence of many new capillaries. sakitamiwa classification
The system organizes the ulcer healing process into three main phases: , Healing (H) , and Scarring (S) . Each of these phases is further divided into two substages, creating a standardized staging system of A1, A2, H1, H2, S1, and S2, which form the basis for the Sakita-Miwa Classification. The red scar turns white, indicating a mature
This stage represents the initial, most severe phase of the ulcer where the lesion is fully formed and active. PubMed Central (PMC) (.gov) A1 (Active 1): The system organizes the ulcer healing process into
: The surrounding tissue edema begins to subside, clearing up the boundaries of the wound. The ulcer crater remains deep, but a delicate, thin red halo (marginal zone) begins to encircle the white slough, signaling that the body is preparing to transition into a healing phase. Surrounding mucosal folds begin converging uniformly toward the ulcer edge. 2. The Healing Stage (H)
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
| Feature | | Modified Sakita-Miwa | Forrest Classification | | :--- | :--- | :--- | :--- | | Primary Purpose | Staging the natural history of an ulcer's healing process | Adapted version for specific contexts (e.g., post-band ligation ulcers) | Assessing the risk of re-bleeding from an ulcer | | Key Focus | Presence of fibrin slough, regenerating epithelium, scarring | Often customized definitions, but based on the core A-H-S framework | Presence and type of stigmata of recent hemorrhage (e.g., active bleeding, visible vessel, clot) | | Main Application | Assessing ulcer activity, healing, and completeness of mucosal repair | Research or specialized clinical scenarios (e.g., variceal banding ulcers) | Emergency and acute management of upper GI bleeding | | Stages | A1, A2, H1, H2, S1, S2 (6 stages) | Varies; often focuses on healing stages (e.g., H1, H2, S1) | Ia (spurting), Ib (oozing), IIa (visible vessel), IIb (adherent clot), IIc (flat spot), III (clean base) |