Sakitamiwa Classification [2025]

The ulcer becomes shallower as granulation tissue fills the base. Regenerating epithelium (new skin) begins to creep in from the edges, often creating a "palisade" appearance of mucosal folds.

The is a standardized endoscopic grading system used primarily by gastroenterologists to assess the life cycle and healing stages of peptic ulcers (both gastric and duodenal). Developed by Japanese researchers Sakita and Miwa, it divides the progression of an ulcer into three main stages— Active (A) , Healing (H) , and Scarring (S) —each further subdivided into two substages. sakitamiwa classification

In this stage, the ulcer is "active" and often associated with the highest risk of complications like bleeding. The ulcer becomes shallower as granulation tissue fills

The edema at the ulcer margin begins to subside, and the ulcer base appears cleaner. The white coating may begin to thin. 2. Healing Stage (H1 & H2) Developed by Japanese researchers Sakita and Miwa, it

The ulcer is significantly smaller. The regenerating epithelium covers most of the base, leaving only a tiny central defect. 3. Scarring Stage (S1 & S2)

Over weeks or months, the redness fades into a white or pale scar as the tissue matures. This marks the final stage of healing. Clinical Utility and Scoring