Ulcerative colitis (UC) is a chronic disease affecting the large intestine, with an increasing incidence worldwide. Nearly 1 million individuals each in the United States and Europe are affected by this condition and many more globally. Over the past decade, since the publication of the last guideline from the American College of Gastroenterology (ACG) on this topic, the management of disease has grown increasingly complex with availability of additional therapeutic classes. In addition, algorithms for initiating, optimizing, and monitoring response to existing therapies have undergone considerable evolution.