The ulcer has fully re-epithelialized (closed), leaving a bright red scar (red scar).

Regenerating epithelium (reddish area) appears at the ulcer margin; ulcer becomes shallower .

: 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.

carries a higher risk of gastrointestinal bleeding, necessitating aggressive acid-suppression therapy or even endoscopic intervention. Conversely, reaching the

The system divides the ulcer life cycle into three primary stages: , Healing (H) , and Scarring (S) . Each stage is further divided into two substages (1 and 2) to provide a granular view of the mucosal defect’s status. 1. Active Stage (A)

Thinning of the white exudative coating; a clear zone of red, regenerating epithelium begins to creep inward from the ulcer margins.

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

The redness fades, and the area becomes white and flat, blending with the surrounding mucosa (White Scar) .

The swelling around the edges begins to subside, but the white coating remains thick and the ulcer crater is still very distinct. Healing Phase (H)

: The resolution phase where mucosal continuity is fully restored.

The system divides ulcer progression into (Active, Healing, and Scarring), with each further subdivided into two sub-stages: 1. Active Stage (A) This stage represents the early, acute phase of the ulcer.

: The ulcer becomes remarkably small and shallow. The white exudate coating is reduced to a tiny central speck or a very thin film. The surrounding regenerative epithelium covers the vast majority of the previous defect, and mucosal folds clearly converge directly toward the healing center. 3. The Scarring Stage (Stage S)

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This is the final stage where the ulcer has effectively closed.

The is a widely recognized endoscopic system used to evaluate the life cycle and healing progress of peptic ulcers, including gastric and duodenal ulcers. By categorizing ulcers into specific stages, clinicians can standardize the assessment of treatment efficacy, monitor healing quality, and predict the risk of complications like rebleeding. The Three Main Stages and Six Substages