Sakitamiwa Classification New! Jun 2026

The system divides ulcer progression into (Active, Healing, and Scarring), with each further subdivided into two sub-stages: 1. Active Stage (A) This stage represents the early, acute phase of the ulcer.

The ulcer is significantly shallower and smaller, often appearing as a thin, linear ulcer or a small spot, showing substantial regeneration. Scar Stage (S1, S2)

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

The ulcer has a white, deep base with sharp, surrounding inflammation. sakitamiwa classification

The Sakita-Miwa classification, proposed in 1971 by Sakita and Miwa, is a widely used endoscopic staging system for peptic ulcers, particularly popular in East Asia. It classifies ulcers into three main stages—active (A), healing (H), and scarring (S)—based on their endoscopic appearance, allowing clinicians to evaluate ulcer activity and healing progress.

When undergoing an endoscopy for gastric (stomach) ulcers, your doctor needs a standardized way to track how well the ulcer is healing. The is a widely used, objective grading system that allows physicians to track the progress of peptic ulcers from their active state to complete healing.

Furthermore, researchers at the KEMRI-Wellcome Trust have trained a deep learning model (ResNet-50) on retinal photographs of Sakitamiwa patients. Microvascular changes – microaneurysms and cotton-wool spots – correlate with EAI and can predict progression to Stage III with 24-hour lead time (AUC 0.91). If validated, this non-invasive "Sakitamiwa Retinal Index" could replace blood-based staging in primary care. The system divides ulcer progression into (Active, Healing,

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Patients staged within 48 hours of fever onset who receive stage-appropriate therapy (e.g., early ribavirin for Stage I; plasma exchange for Stage III) have a 54% relative risk reduction in progression to Stage IV (NNT = 6). Importantly, the Classification also identifies a subset of (> 5,000 ng/mL) – termed "Sakitamiwa Macrophage Activation Syndrome" – which responds to anakinra (IL-1 blockade) but not corticosteroids.

In rheumatology, the system is used to classify synovial proliferative disorders, helping surgeons decide between arthroscopic debridement (for Sak-A/B) versus synovectomy or arthroplasty (for Sak-C/D). Scar Stage (S1, S2) The Sakita-Miwa classification is

This is the most acute phase. The ulcer is characterized by a thick, white slough (exudate) covering the base. The margins are sharp and swollen (edematous), and there are no visible mucosal folds reaching the ulcer. A2 (Active-2):

The edema begins to subside, and the ulcer margins become clearer. The mucus coating remains prominent. 2. Healing Stage (H) In this stage, signs of tissue repair become visible.

This classification is crucial for tracking the efficacy of ulcer treatments, including PPIs and P-CABs (such as vonoprazan ), in both gastric and duodenal ulcers. The Three Stages of Sakita-Miwa Classification