The charred landscape from this active lava flow is an appropriate metaphor for the processes underway within the colonic mucosa in patients with ulcerative colitis (UC). Colitis may be visualized as a ‘first-degree burn" of the colon that is diffuse, contiguous, confluent, circumferential, symmetrical, and superficial. UC is an immune-mediated disease occurring in genetically susceptible patients. It may be secondary to environmental factors or antigens exposed to the gut. Overall, UC is more common than Crohn's disease, has a bimodal peak, is seen in families, and has multiple extra-intestinal manifestations. Patients usually present with intermittent diarrhea, pain, and bleeding.