By standardizing how mucosal injuries are visually assessed during upper gastrointestinal (GI) endoscopies, the classification provides a critical roadmap for evaluating drug efficacy, determining bleeding risks, and guiding patient recovery timelines. The Three Major Eras of Ulcer Healing
Sakita-Miwa classification (also known as the Sakita and Miwa scale) is
The defect becomes much smaller. New regenerating epithelium covers most of the ulcer floor, though a small white coating may still be visible. Scarring Phase (S) sakitamiwa classification
[A1: Acute Active] ──> [A2: Defined Active] ──> [H1: Early Healing] │ [S2: Mature Scar] <── [S1: Red Scarring] <── [H2: Advanced Healing] 1. The Active Stage (Stage A)
It is the standard for measuring the speed of healing in randomized controlled trials for acid-suppressing drugs. By standardizing how mucosal injuries are visually assessed
Vascular malformations
The white coating has completely disappeared, and new epithelium fully covers the floor. Because the new tissue is thin and has many blood vessels, it appears as a "red scar". Scarring Phase (S) [A1: Acute Active] ──> [A2:
Over several months to years, the redness fades. The scar becomes the same color as the surrounding tissue, often appearing as a "white scar".
The Sakita-Miwa classification is more than just a descriptive list; it is a critical diagnostic guide. For instance, an ulcer in the
Conversely, East Asian clinical workflows frequently employ both systems. While Forrest assists in acute emergency management, the Sakita-Miwa classification provides a chronological, high-resolution map of tissue architecture repair over weekly and monthly follow-ups. Applications in Modern Clinical Trials
: 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