The is a standardized endoscopic grading system used primarily by gastroenterologists to assess the life cycle and healing stages of peptic ulcers (both gastric and duodenal). Developed by Japanese researchers Sakita and Miwa, it divides the progression of an ulcer into three main stages— Active (A) , Healing (H) , and Scarring (S) —each further subdivided into two substages.
The edema at the ulcer margin begins to subside, and the ulcer base appears cleaner. The white coating may begin to thin. 2. Healing Stage (H1 & H2)
This classification is a critical tool in clinical trials to evaluate the efficacy of acid-suppressing drugs like Proton Pump Inhibitors (PPIs) and Potassium-Competitive Acid Blockers (P-CABs) .
In modern research, doctors often assign numerical scores to these stages to quantitatively measure improvement. For example, a study on ischemic colitis or Behçet’s disease might use the following scale: Clinical Meaning Numerical Score (Example) Highly Active / Deep A2 Active / Slightly Improved H1 Early Healing H2 Advanced Healing S1 Red Scar (Healed) S2 White Scar (Mature) Why is this Classification Important?
The ulcer is deep with a thick, white or yellowish-gray coating (slough) at the base. The margins are sharp and often swollen with edema.
This transition indicates that medical treatment or natural recovery is effectively closing the wound.
The ulcer base is completely covered by new epithelium, but the area remains red and vascularized. This is a "fresh" scar.
The ulcer is significantly smaller. The regenerating epithelium covers most of the base, leaving only a tiny central defect. 3. Scarring Stage (S1 & S2)
The system tracks an ulcer from its most aggressive, open state to its final resolution as a healed scar.
Over weeks or months, the redness fades into a white or pale scar as the tissue matures. This marks the final stage of healing. Clinical Utility and Scoring
The is a standardized endoscopic grading system used primarily by gastroenterologists to assess the life cycle and healing stages of peptic ulcers (both gastric and duodenal). Developed by Japanese researchers Sakita and Miwa, it divides the progression of an ulcer into three main stages— Active (A) , Healing (H) , and Scarring (S) —each further subdivided into two substages.
The edema at the ulcer margin begins to subside, and the ulcer base appears cleaner. The white coating may begin to thin. 2. Healing Stage (H1 & H2)
This classification is a critical tool in clinical trials to evaluate the efficacy of acid-suppressing drugs like Proton Pump Inhibitors (PPIs) and Potassium-Competitive Acid Blockers (P-CABs) .
In modern research, doctors often assign numerical scores to these stages to quantitatively measure improvement. For example, a study on ischemic colitis or Behçet’s disease might use the following scale: Clinical Meaning Numerical Score (Example) Highly Active / Deep A2 Active / Slightly Improved H1 Early Healing H2 Advanced Healing S1 Red Scar (Healed) S2 White Scar (Mature) Why is this Classification Important?
The ulcer is deep with a thick, white or yellowish-gray coating (slough) at the base. The margins are sharp and often swollen with edema.
This transition indicates that medical treatment or natural recovery is effectively closing the wound.
The ulcer base is completely covered by new epithelium, but the area remains red and vascularized. This is a "fresh" scar.
The ulcer is significantly smaller. The regenerating epithelium covers most of the base, leaving only a tiny central defect. 3. Scarring Stage (S1 & S2)
The system tracks an ulcer from its most aggressive, open state to its final resolution as a healed scar.
Over weeks or months, the redness fades into a white or pale scar as the tissue matures. This marks the final stage of healing. Clinical Utility and Scoring
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Tim Wilkinson
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