Corticosteroid-free remission may be defined based on symptoms, endoscopic findings, or disease impact without ongoing corticosteroid use. Symptomatic remission relates to improvement in PROs, whereas endoscopic healing is defined as restoration of intact mucosa without friability. Deep remission is a combination of symptomatic remission and endoscopic healing and is a preferred goal of management. 11. Selection of induction and maintenance therapies for UC should be based on disease extent, severity, and prognosis. 12. Initial treatment of UC should focus on restoration of normal bowel frequency and control of the primary symptoms of bleeding and urgency. An endoscopically healed mucosa is associated with sustained remission and reduced risk of colectomy. 13. Histologic remission is associated with some improved clinical outcomes but has not yet been validated prospectively as an end point of treatment. 14. Control of mucosal inflammation may reduce dysplasia risk. 15. Given the chronic nature of UC and the therapies for UC, monitoring for disease-related and drug-related complications is important. This should incorporate preventive strategies as outlined here and in a separate guideline from the ACG (12). 16. Routine visits are recommended to monitor for relapse and address health maintenance needs. 17. Patients with UC should be screened for coexistent anxiety and depressive disorders, and when identified, patients should be provided with resources to address these conditions. Recommendations 4. We suggest treating patients with UC to achieve mucosal healing (defined as resolution of inflammatory changes (Mayo endoscopic subscore 0 or 1)) to increase the likelihood of sustained steroid-free remission and prevent hospitalizations and surgery (conditional recommendation, low quality of evidence). 5. We suggest FC as a surrogate for endoscopy when endoscopy is not feasible or available to assess for mucosal healing (conditional recommendation, very low quality of evidence). Summary of evidence Patients' and providers' goals may not always align. Studies have identified disparities between QoL measures as perceived by patients and their providers (73). Symptoms alone should not be used as the only measure of remission, and patients need to be educated about these concepts, as symptomatic remission can lag behind healing (74). In addition, a large portion of patients with UC have been shown to have mucosal inflammation without clinical symptoms (75). Therefore, it is important to rely on objective clinical targets and use validated scores and instruments (including endoscopy) in confirming remission (60,76). According to Food and Drug Administration guidance, a PRO involves the generation of items from qualitative patient interviews and testing for reliability and responsiveness to changes in clinical health (77). An optimized PRO derived from the Mayo score and the SCCAI has been validated (55). Resolution of rectal bleeding and urgency, normalization of bowel habits, and improvement in general well-being should be the goal for patient-reported symptoms. Disease activity indexes used in clinical trials can be used to define steroid-free remission. These include the Mayo score (46), Rachmeliwitz Index (48), SCCAI (49), and PUCAI (54). Targets have been defined for the treatment of UC, and goals of therapy should be directed at these targets. A treat-to-target approach uses regular assessment of disease activity