, also known as the "Red Scar" (或红色瘢痕期) , is defined by the complete covering of the ulcer floor by regenerating epithelium . The white fibrin coating has completely disappeared, leaving a smooth, flat surface. This new scar tissue is highly vascular and appears markedly red , often standing out prominently against the surrounding paler mucosa. Under close observation, many tiny capillaries and blood vessels can be seen coursing through this fresh scar.
(Scar 1 - Red Scar): The ulcer is no longer present; it has healed completely. The area is covered in new epithelium, which appears red and inflamed (red scar). S2cap S sub 2
Before the widespread adoption of endoscopic staging systems, the clinical description of gastric ulcers was often subjective and varied between different physicians and institutions. This inconsistency made it difficult to accurately track a patient's progress, compare the effectiveness of different treatments, or design meaningful clinical trials. The Sakita-Miwa classification was developed to solve these problems by providing a clear, objective, and universal framework.
The ulcer base is completely covered by new epithelium, but the area remains red and vascularized. This is a "fresh" scar.
(Active 2): The ulcer shows signs of early healing, but the white-plaque coating remains significant. The surrounding edema begins to reduce, and the margins become slightly better defined. H-Stage (Healing Stage) sakitamiwa classification
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[A1: Acute Active] ──> [A2: Defined Active] ──> [H1: Early Healing] │ [S2: Mature Scar] <── [S1: Red Scarring] <── [H2: Advanced Healing] 1. The Active Stage (Stage A)
The central white slough becomes remarkably small, fragmented, or patch-like, rendering the overall ulcer depth shallow. Regenerating mucosal folds visibly converge from the periphery toward the central core of the wound, highlighting accelerated healing and wound contraction. 3. The Scarring Stage (S-Stage)
The classification of disease is the fundamental backbone of medical practice. In biomedicine, classification systems like the ICD-11 categorize diseases based on distinct biological markers. However, in many developing nations and indigenous communities, "Folk Illnesses" persist. These are syndromes recognized only within a specific culture, often lacking direct equivalents in Western nosology. , also known as the "Red Scar" (或红色瘢痕期)
Clinical trials use this to measure the success of therapies (like PPIs or rebamipide) in healing ulcers.
: It allows doctors to quantitatively score the quality and speed of ulcer healing, often used to test the effectiveness of medications like Proton Pump Inhibitors (PPIs) Rebamipide Procedure Monitoring
To understand Sakitamiwa, one must adopt an (the insider's view) rather than the etic perspective (the outsider/scientific view).
The ulcer is very shallow and nearly covered by new tissue. The surrounding inflammation has largely disappeared. PubMed Central (PMC) (.gov) 3. Scarring Stage (S) Under close observation, many tiny capillaries and blood
marks the transition from an active to a healing ulcer. The distinguishing features of H1 are the thinning of the white fibrin coating and the extension of regenerating epithelium across the ulcer base . The ulcer crater is still evident, but the gradient between the ulcer margin and its base becomes flatter. The diameter of the mucosal defect is now about one-half to two-thirds of its original A1 size.
The system organizes the ulcer healing process into three main phases: , Healing (H) , and Scarring (S) . Each of these phases is further divided into two substages, creating a standardized staging system of A1, A2, H1, H2, S1, and S2, which form the basis for the Sakita-Miwa Classification.
While the Sakita-Miwa classification is the most widely accepted endoscopic staging system, it is sometimes helpful to compare it with other schemes that a clinician might encounter.