Ulcerative colitis (UC) is a chronic inflammatory condition affecting the colon and rectum, typically diagnosed around ages 30-40 with equal incidence in men and women. Its multifactorial pathogenesis involves environmental triggers, immune dysfunction, and potential microbial imbalance in genetically predisposed individuals. UC management is primarily aimed at symptom control, as the disease lacks curative treatments aside from colectomy, with therapies often required lifelong due to its chronic nature. Patients experience alternating periods of remission and exacerbations, sometimes necessitating intensified treatment or hospitalization, and in severe cases, surgical intervention.

Historically reliant on corticosteroids, UC treatment has evolved rapidly with the advent of small molecule and biologic therapies, offering alternatives to manage symptoms effectively. Following the success of anti-tumor necrosis factor α (anti-TNFα) biologics, subsequent therapeutic developments have targeted various immune pathways including adhesion molecules, cytokines (IL-12/23, TL1A, IL-36), Janus kinase (JAK), and phosphodiesterase. Despite the transformative impact of these therapies, many patients still require alternative options due to adverse effects or treatment failure, driving the development of novel agents with improved safety profiles and efficacy. Emerging strategies also focus on modulating less-targeted immune cells (B cells, innate lymphoid cells), addressing fibrosis, regulating the gut-brain axis, and optimizing host-microbiome interactions, promising innovative approaches for future UC management. Ongoing translational research underscores the potential of these advancements, providing a comprehensive outlook on current and forthcoming IBD therapeutics.