Sakitamiwa Classification !new! Jun 2026

The system was created in 1970 by Japanese physicians Takao Sakita and Tsuyoshi Miwa at the National Cancer Center in Japan. It was based on years of careful endoscopic observation of gastric ulcers as they formed and healed. Their innovative work provided, for the first time, a structured way to categorize the morphological changes of a peptic ulcer over time.

The ulcer begins to shrink. The white coating becomes thinner, and regenerating epithelium (new skin) starts to extend into the base. Mucosal folds may begin to converge toward the ulcer margin. H2 (Healing-2):

: The white coating becomes thin, and new epithelium significantly extends into the ulcer base. The ulcer crater is still visible, but its diameter is reduced to about one-half or two-thirds of the A1 size. sakitamiwa classification

The red scar has matured into a white scar, indicating the final stage of the healing process. 2. Clinical Significance and Application

It is important not to confuse the Sakita-Miwa classification with another common endoscopic scoring system for ulcers: the . The system was created in 1970 by Japanese

It provides an objective endpoint for measuring ulcer healing rates in clinical trials, such as comparing the effectiveness of different Proton Pump Inhibitors (PPIs).

The following table outlines the expected endoscopic findings for each of the six stages within the Sakita-Miwa Classification: The ulcer begins to shrink

At this point, the ulcer is considered "endoscopically cured" because the mucosal defect has vanished.