Sakitamiwa Classification | QUICK · Tips |

Unlike linear systems (e.g., sepsis staging), the Sakitamiwa Classification integrates three pathognomonic axes:

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

| Phase | Stage | Description of Endoscopic Findings | | :--- | :--- | :--- | | | A1 | The surrounding mucosa is edematously swollen . There is no visible regenerating epithelium. A thick white slough or fibrin layer covers the ulcer base. | | | A2 | The surrounding edema has decreased , making the ulcer margin clearer. A slight amount of regenerating epithelium is visible at the ulcer margin. A red halo and a white slough around the ulcer margin are frequently seen. | | Healing | H1 | The white coating on the ulcer base is becoming thinner . The regenerating epithelium is visibly extending into the ulcer base. The ulcer crater is still evident, but the gradient between the margin and the floor is becoming flat. The mucosal defect is approximately 50-66% of its size at stage A1. | | | H2 | The mucosal defect is smaller than in H1. The regenerating epithelium now covers most of the ulcer floor . The area of white coating is about 25-33% of its size at stage A1. | | Scarring | S1 | The regenerating epithelium has completely covered the ulcer floor, and the white coating has disappeared. The new epithelium is markedly red due to its rich capillary network. This is known as a "red scar." | | | S2 | The redness of the scar has gradually faded over several months to a few years, and the area now closely matches the color of the surrounding mucosa . This is known as a "white scar." | Unlike linear systems (e

This system is frequently used in clinical research, such as Randomized Clinical Trials , to evaluate the effectiveness of Proton Pump Inhibitors (PPIs) or other ulcer-healing medications. A thick white slough or fibrin layer covers the ulcer base

The name "Sakitamiwa" is derived from the pioneering researchers—Dr. Kenji Sakitami and Dr. Yuki Miwa—who first proposed the taxonomy in the late 1990s to address discrepancies in inter-observer variability among pathologists. The system was officially adopted by several Asian and European medical boards in the mid-2000s and has since undergone three major revisions, the latest being the Sakitamiwa Classification 3.0 (2020).

: This is the peak of acute tissue damage. Endoscopically, the gastric or duodenal wall exhibits localized thickening. The ulcer crater is deep and punch-like, filled with a dense, white-yellow slough or exudate. A key hallmark of this stage is the lip-like sign , where the severely edematous edge of the ulcer protrudes noticeably over the crater.

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