The system is a crucial, widely utilized endoscopic staging system designed to assess the activity and healing progress of peptic ulcers, particularly gastric ulcers. Developed to provide a standardized, objective language for gastroenterologists, this classification system maps the evolutionary stages of an ulcer from its active, inflamed state through to complete scar formation.

This phase is characterized by the active regrowth of new tissue (regenerating epithelium) over the ulcer crater. The progression from H1 to H2 shows the ongoing reduction in the size of the ulcer defect.

Understanding this system is essential for evaluating the effectiveness of ulcer treatments (like proton pump inhibitors or potassium-competitive acid blockers) and determining the success of endoscopic therapies. 1. The Stages of Sakita-Miwa Classification

Over time, the redness fades as the capillaries decrease, and the area becomes a pale, "white scar" that eventually blends with the surrounding normal mucosa. Summary Table Key Endoscopic Feature Active (A) A1 Thick slough, significant edema, no regeneration A2 Clearer margins, reduced edema, initial regeneration Healing (H) H1 Thin slough, defect reduced by ~50%, more regeneration H2 Minimal slough, defect mostly covered by new tissue Scarring (S) S1 Red scar; no slough; complete epithelial coverage S2 White scar; pale appearance; fully healed

It helps detect endoscopic findings like compound ulcers or those associated with other conditions, such as superior mesenteric artery syndrome.

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)

Sakita-Miwa classification (also known as the Sakita and Miwa scale) is

The Sakita-Miwa classification is heavily used in clinical trials and day-to-day practice in Japan and other East Asian countries to:

| Resource Level | Minimum required for Stages I–II | For Stages III–IV | |----------------|----------------------------------|------------------| | (clinic) | Tourniquet test, platelet count, urine dipstick | Transfer to district hospital | | Medium (hospital) | Rapid NS1 antigen test, bedside ultrasound for ascites | Complete blood count, ALT, creatinine, chest X-ray | | High (tertiary) | Quantitative RT-PCR for V-score, serum angiopoietin-2 | CT brain, continuous renal replacement therapy |