Ulcerative Colitis is a chronic immune-mediated inflammatory disorder of the colorectum with bimodal age distribution with an incidence peak in the 2^nd or 3^rd decades and followed by second peak between 50 and 80 years of age. It usually presents with  bloody diarrhea, urgency and  anemia. It causes continuous mucosal inflammation extending from the rectum to the proximal colon. Pathogenesis involves inappropriate mucosal immunologic response to gut microbiota and other environmental factors in a genetically predisposed individual. At present treatment is directed to dysregulated immune response and is limited by moderate efficacy, side effects (infections and malignancy) and cost, especially in developing countries, where the disease burden of IBD is rising.

Corticosteroids are used in moderate to severe acute flare ups; however, their use should be restricted to no more than 2-3 months due to risk of serious side-effects. Moreover, a subset of patients either do not respond to steroids and require step- up therapy or are unable to taper off steroids. Other treatment options in patients with moderate to severe ulcerative colitis include either ciclosporin /tacrolimus, TNF antagonists or colectomy.

Tofacitinib, an oral, small-molecule Janus kinase inhibitor has been shown to have potential efficacy as induction and maintenance therapy for ulcerative colitis. Its usage appears attractive due to its rapid onset of action, rapid clearance, predictable pharmacokinetics and lack of immunogenicity, decreased susceptibility to colonic loss, widespread availability, and lower costs compared with other therapies.

The diversity of composition of intestinal microbiota is lower in UC patients as it contains less numbers of Firmicutes (Clostridium clusters XIVa and IV) and Bacteroidetes. Although no cause or effect relationship has yet been established, modulation of gut microbiota is associated with improved outcomes in ulcerative colitis in different RCTs. Fecal  microbiota transplantation (FMT) defined as infusion of Fecal  suspension from a healthy individual into the gastrointestinal tract of an individual with GI disease carries a diverse population of microbiota and their metabolites has shown good success rates in randomized control trials in patients with UC who failed conventional agents. Fecal microbiota transplantation has also demonstrated short-term as well as long-term safety in patients with Clostridioides difficile colitis and ulcerative colitis, even in patients on immunosuppression.