| Summary: | <i>Background: </i> Ulcerative colitis (UC) is being reported more frequently among the Arabs. Information on the clinical severity, endoscopic and histological grading is scanty. <i> Aim: </i> To assess the severity of the disease and its response to therapy in patients referred to a tertiary care referral centre in Gassim region, Kingdom of Saudi Arabia (KSA). <i> Patients and Method: </i> Hospital records of thirty-four patients found to have UC from 1990-2002 were analyzed. The study included clinical severity, endoscopical and histological assessment, response to therapy and frequency of complications. <i> Results: </i> There were 21 males and 13 females with median age 35 (range: 18-76) years. The disease was clinically mild in seven patients (21%), moderate in 11 (32%) and severe in 16 (47%). Endoscopically UC was graded as 2 in three patients (9%), 3 in 21 patients (59%) and 4 in ten patients (29%). Histologically UC was mild to moderate in 11 patients (32%) and severe in 23 (68%). Extent of UC was total in nine patients (26%), up to transverse colon in six (18%), splenic flexure in 14 (41%), rectosigmoid region in four (12%) and only up to the rectum in one (3%). Twenty-nine patients (85%) were treated with salazopyrine and five patients (15%); (two of them were hypersensitive to salazopyrine) received 5-aminosalicylic acid. Proctocolectomy was performed in two with a focus of malignancy. No patient died during the median follow-up period of 48 months (range: 4 months to 12 years). <i> Conclusion: </i> Ulcerative colitis presented with varying severity, more frequently in males in the population studied. Most of the patients responded to salazopyrine and surgery was necessary when malignancy was detected
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