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Ulcerative colitis (UC) is a chronic, inflammatory bowel disease (IBD); characterized by abdominal pain, bloody diarrhea and several extra-intestinal manifestations. Evidence has accumulated that hyperbaric oxygen therapy (HBOT) also has potent anti-inflammatory effects and may normalize oxygen levels in ischemic tissues. The aim of this study was to evaluate the efficacy of hyperbaric oxygen (HBO) as an adjuvant therapy in severe UC patients. A randomized controlled trial was conducted on 20 Egyptian patients with severe UC according to truelove and witt’s criteria divided into two groups each one composed of 10 patients: the first one received 10 sessions of HBOT 5 times per week for 2 weeks plus 400 mg hydrocortisone and intravenous (IV) fluids while the second one received 400 mg hydrocortisone plus IV fluids with follow up of inflammatory markers for both groups as erythrocyte sedimentation rate (ESR), C Reactive protein (CRP), Fecal calprotectin at day 1, 3, 7 and 14 of the study and follow up of their Rectal bleeding score (RBS), Stool frequency score(SFS) and Mayo endoscopic score (MES) to assess therapeutic effect of HBOT. Our results showed significant decrease in ESR, CRP, faecal calprotectin, RBS, SFS and MES levels in group I when compared to group II at day 14 of the study. So we concluded that hyperbaric oxygen therapy has an effective and safe effect for severe UC patients beside conventional therapies to avoid second lines therapy.