Exosomes, a subclass of Extracellular Vesicles (EVs), are pivotal mediators of intercellular communication. Exosomes derived from Mesenchymal Stem Cells (MSCs) exhibit anti-inflammatory and immunomodulatory activities similar to that of their parental cells, which makes them a cell-free treatment strategy against Ulcerative Colitis (UC). Engineered MSC Exosomes (MSC-Exos) hold the potential to impart multifunctionality to MSCs and optimize their therapeutic effectiveness. This study provides a comprehensive overview of the research progress, mechanisms of action, and potential applications of MSC-Exos and engineered MSC-Exos in the treatment of UC.