Ulcerative colitis is a chronic inflammatory disease of the colon, with increasing global incidence. It involves genetic, environmental, and immune factors, and typically presents with rectal bleeding and diarrhea. Diagnosis is made via colonoscopy and histology. Treatment aims to induce and maintain remission, with options including 5-aminosalicylic acid (5-ASA), steroids, immunosuppressants, and biologics. Colectomy may be required for severe or refractory cases. The therapeutic options are expanding, with new drugs targeting various pathways expected to increase in the future. The disease is characterized by relapsing and remitting mucosal inflammation starting in the rectum and extending proximally. Risk factors include family history, smoking, and certain environmental exposures. Epidemiologically, incidence and prevalence are rising globally, with higher rates in northern Europe, Canada, and Australia. Prevalence is highest in Europe, Canada, and the USA. Risk factors for aggressive disease include younger age at onset, pancolitis, and certain immune markers. Pathophysiology involves epithelial barrier defects, immune dysregulation, and dysbiosis. Innate and adaptive immunity play key roles, with Th2 and Th17 pathways implicated. The disease is associated with extraintestinal manifestations and increased risk of colorectal cancer. Management focuses on inducing remission, with 5-ASA as first-line therapy for mild to moderate disease. Corticosteroids and biologics are used for severe cases. Surgery, such as restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA), is considered for refractory disease. Long-term management includes regular surveillance for colorectal cancer, health maintenance, and monitoring for complications. Treat-to-target strategies aim for endoscopic and clinical remission. New drugs, including JAK inhibitors and anti-integrin therapies, are being developed. Biosimilars may reduce costs, but immunogenicity remains a concern. Fecal microbiota transplantation shows mixed results. Precision medicine is becoming increasingly important, with a focus on personalized treatment based on genetic and biomarker data. Future research aims to improve treatment strategies and outcomes for patients with ulcerative colitis.Ulcerative colitis is a chronic inflammatory disease of the colon, with increasing global incidence. It involves genetic, environmental, and immune factors, and typically presents with rectal bleeding and diarrhea. Diagnosis is made via colonoscopy and histology. Treatment aims to induce and maintain remission, with options including 5-aminosalicylic acid (5-ASA), steroids, immunosuppressants, and biologics. Colectomy may be required for severe or refractory cases. The therapeutic options are expanding, with new drugs targeting various pathways expected to increase in the future. The disease is characterized by relapsing and remitting mucosal inflammation starting in the rectum and extending proximally. Risk factors include family history, smoking, and certain environmental exposures. Epidemiologically, incidence and prevalence are rising globally, with higher rates in northern Europe, Canada, and Australia. Prevalence is highest in Europe, Canada, and the USA. Risk factors for aggressive disease include younger age at onset, pancolitis, and certain immune markers. Pathophysiology involves epithelial barrier defects, immune dysregulation, and dysbiosis. Innate and adaptive immunity play key roles, with Th2 and Th17 pathways implicated. The disease is associated with extraintestinal manifestations and increased risk of colorectal cancer. Management focuses on inducing remission, with 5-ASA as first-line therapy for mild to moderate disease. Corticosteroids and biologics are used for severe cases. Surgery, such as restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA), is considered for refractory disease. Long-term management includes regular surveillance for colorectal cancer, health maintenance, and monitoring for complications. Treat-to-target strategies aim for endoscopic and clinical remission. New drugs, including JAK inhibitors and anti-integrin therapies, are being developed. Biosimilars may reduce costs, but immunogenicity remains a concern. Fecal microbiota transplantation shows mixed results. Precision medicine is becoming increasingly important, with a focus on personalized treatment based on genetic and biomarker data. Future research aims to improve treatment strategies and outcomes for patients with ulcerative colitis.