{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T13:10:11Z","timestamp":1777295411865,"version":"3.51.4"},"reference-count":52,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JGH Open"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Ulcerative colitis (UC) is traditionally managed with long\u2010term 5\u2010aminosalicylic acid (5\u2010ASA) administration. However, in real\u2010world practice, carefully selected low\u2010risk patients in sustained deep remission may remain stable without continuous therapy. Randomized trials have shown only modest differences in relapse between 5\u2010ASA and placebo treatment, and real\u2010world experience indicates that requests to discontinue 5\u2010ASA during sustained remission are not uncommon. Importantly, symptom\u2010based assessments can be misleading. Psychosocial factors and a disconnect between symptoms and inflammation, including irritable bowel syndrome overlap, may explain the observed differences. Noninvasive biomarkers, such as fecal calprotectin and serum leucine\u2010rich alpha\u20102 glycoprotein, allow the early detection of subclinical inflammation, supporting the feasibility of a drug\u2010free active surveillance (DFAS) strategy in selected patients. Biomarker\u2010guided monitoring can reduce the reliance on colonoscopy and make DFAS more acceptable in practice. Consistent with treat\u2010to\u2010target and disease clearance strategies, prioritizing endoscopic and histologic remission, stable biomarkers, and favorable psychosocial conditions may help identify appropriate candidates. A patient\u2010centered implementation strategy that integrates patient\u2010reported outcomes, mental health assessments, and shared decision\u2010making can ensure that DFAS reflects proactive, individualized care rather than therapeutic neglect. Given the growing UC population and disease burden, increasing healthcare costs, and patient preferences to minimize long\u2010term medication, this review defines the clinical rationale, candidate selection criteria, and a pragmatic biomarker\u2010guided algorithm for selective DFAS after 5\u2010ASA in UC and outlines a research agenda to validate safety, feasibility, and cost\u2010effectiveness. We propose that DFAS be reserved for low\u2010risk patients under structured surveillance with predefined relapse triggers and rapid rescue pathways.<\/jats:p>","DOI":"10.1002\/jgh3.70399","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T07:06:02Z","timestamp":1775631962000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Selective Drug\u2010Free Active Surveillance in Ulcerative Colitis: Biomarker\u2010Guided, Patient\u2010Centered Approach"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4037-9003","authenticated-orcid":false,"given":"Tsutomu","family":"Nishida","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Toyonaka Municipal Hospital  Osaka 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