Sakitamiwa Classification

The system is divided into three primary stages, each containing two sub-levels based on the visual appearance of the ulcer during an endoscopy: 1. The Active Stage (A) A1 (Active-1):

The ulcer becomes shallower (flat) as regenerative tissue covers most of the base. The ulcer crater is significantly reduced in size. 3. Scar Stage (S)

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

Understanding the stages of the Sakita-Miwa system is critical for evaluating drug efficacy in clinical trials, assessing bleeding risks, and tracking patient recovery over time. The Structure of the Sakita-Miwa Classification sakitamiwa classification

The surrounding edema decreases, and the ulcer margin becomes clear. A small amount of regenerating epithelium may begin to appear at the very edge of the margin. 2. Healing Stage (H)

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

The classification relies on a scoring system (often adapted from the Indonesian Pediatric Society scoring system) which includes: The system is divided into three primary stages,

The ulcer is considered clinically cured once it reaches this stage, as the white coating has completely disappeared. ScienceDirect.com S1 (Scar-1 / Red Scar):

: A thin white coat of exudate remains at the base, but regenerating epithelium (reddish in color) begins to appear at the margin. The ulcer size noticeably shrinks. healthy mucosa. At this point

This stage represents the initial, acute phase of the ulcer where the mucosal defect is most prominent.

: Over a period of several months to a couple of years, the intense capillary network undergoes physiological regression. The color of the region fades completely, presenting as a white, pale scar that matches or blends smoothly into the surrounding normal gastric mucosa. Clinical Significance and Global Context East Asian vs. Western Endoscopic Paradigms

The Sakitamiwa classification groups congenital cutaneous and soft-tissue anomalies into four actionable categories—vascular malformations, vascular tumors, hamartomas/overgrowth syndromes, and developmental epidermal/dermal defects—emphasizing morphology, natural history, diagnostics, and tailored management to guide clinicians toward appropriate care.

The system categorizes ulcers into three main stages, each subdivided into two further phases. 1. Active Stage (Stage A) This represents the acute phase of the ulcer.

, the final stage in the healing process, is called the "White Scar" (或白色瘢痕期) . Over a period ranging from several months to a few years, the intense redness of the S1 scar gradually fades as the vascularity decreases and the tissue matures. Eventually, the color of the scar tissue returns to the same shade as the surrounding, healthy mucosa. At this point, the ulcer is considered fully healed endoscopically.