Sakitamiwa Classification Jun 2026

(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)

The ulcer is deep with a thick white or yellow slough (exudate) at the base. The margins are sharp and often swollen, sometimes referred to as the "lip-like sign".

Further sub-classifications of Sakitamiwa have been proposed based on the predominant symptoms:

| Stage | Phase | Endoscopic Appearance | | :--- | :--- | :--- | | | Active | The surrounding mucosa is edematously swollen and red. No regenerating epithelium is seen. | | A2 | Active | Surrounding edema has decreased. A clear ulcer margin with a slight amount of regenerating epithelium is visible. | | H1 | Healing | The white fibrin coating is becoming thin. Regenerating epithelium is extending into the ulcer base. | | H2 | Healing | The mucosal defect is smaller than in H1. Regenerating epithelium covers most of the ulcer floor. | | S1 | Scarring | Regenerating epithelium completely covers the ulcer floor. The area is markedly red ( red scar ). | | S2 | Scarring | Over several months, the redness fades to match the color of the surrounding mucosa ( white scar ). | sakitamiwa classification

For more specific information on how healing stages are assessed, studies like this randomized trial are useful, say researchers in Gut and Liver (2026).

The ulcer is deep with a distinct white coating (exudate) and a surrounding edematous, inflamed border.

Ulcer shrinks; reddish regenerating epithelium appears at the borders (Active 2): The ulcer shows signs of early

(Disclaimer: This content is for educational purposes. For medical diagnosis and treatment, please consult a licensed physician or current WHO/CDC guidelines.)

Significant reduction in slough; clear signs of marginal regeneration. Ulcer becomes very small; slough is nearly gone. S1 Scarring 1 Red scar; the white coating has completely disappeared. S2 Scarring 2

The white coating begins to shrink, but the margin remains clearly defined and edematous. Healing Stage (H-Stage): The margins are sharp and often swollen, sometimes

signals successful recovery, though clinicians must still monitor for underlying causes like

: The ulcer base is deeply cratered and heavily covered with a thick, white or yellowish-gray necrotic slough (exudate). The margins of the ulcer are sharply defined and severely swollen with prominent edema. Blood clots or exposed vessel stubs may be visibly protruding from the bottom.

In this phase, the body actively repairs the defect by clearing away debris and generating brand-new surface tissue.

The active phase marks the acute stage of the ulcer, where the lesion is at its most aggressive state.

The healing phase signifies a period of active repair, where the body is working to close the mucosal defect. During this stage, the ulcer is no longer considered "active" in the same sense, but healing is incomplete.