This stage represents the initial, acute phase of the ulcer where the mucosal defect is most prominent.
This group includes children where the tuberculosis bacteria are primarily located in the lungs and thoracic cavity.
: This is the acute phase of ulceration. Endoscopically, the ulcer base is deep and heavily coated with a thick, yellowish-white slough or exudate (white plaque). The surrounding mucosal margins are prominently swollen, elevated, and erythematous due to severe edema. Active bleeding or exposed, vulnerable blood vessels may sometimes be observed at this point.
The edema in the surrounding mucosa begins to decrease. The ulcer floor remains covered with slough, but the margins become more distinct. Intestinal Research 2. Healing Stage (H) sakitamiwa classification
: The regenerating epithelium completely covers the ulcer floor, and the white coating has disappeared. The area appears markedly red due to many visible capillaries. S2 (White Scar)
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.
The final stage of healing. The redness disappears, leaving a white, flat scar as fibrous tissue matures and capillary density decreases. Summary Table Clinical Feature Highlights Active Thick white coating, edema, discrete margins Healing Epithelial regeneration, shallower base, shrinking coating Scarring Complete closure; initially red, maturing into a white scar This stage represents the initial, acute phase of
: The surrounding tissue edema begins to subside, clearing up the boundaries of the wound. The ulcer crater remains deep, but a delicate, thin red halo (marginal zone) begins to encircle the white slough, signaling that the body is preparing to transition into a healing phase. Surrounding mucosal folds begin converging uniformly toward the ulcer edge. 2. The Healing Stage (H)
: The thick necrotic coating becomes noticeably thinner, and a small layer of regenerating epithelium begins to creep inward from the edges. The slope between the surrounding stomach wall and the ulcer bed becomes flatter, and the overall diameter of the crater shrinks significantly.
: Healing effects of rebamipide and omeprazole in Helicobacter pylori-positive gastric ulcer patients published in Digestive Diseases (2011). Endoscopically, the ulcer base is deep and heavily
Understanding the Sakita-Miwa Classification: The Gold Standard for Gastric Ulcer Staging
: The ulcer becomes significantly smaller and shallower. The regenerative epithelium covers most of the ulcer base, leaving only a small amount of central white slough. 3. Scarring Stage (S)