Background: Inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn's disease (CD), is becoming increasingly prevalent in North Africa—the current study aimed to evaluate IBD's clinical and treatment outcomes. Methods: This retrospective cohort study was performed at the IBD clinic from June 2019 to July 2024. It included 208 cases with UC and 22 cases with CD. Results: The differences in endoscopic outcomes regarding the type of therapy at 24 weeks follow-up were substantial (P <0.001). A decline in fecal calprotectin (F.C) ≤150 µg/mg was observed in 28.3% (17 cases) of the conventional group and 68.2% (101 cases) of the biological group, showing a highly significant difference in outcomes regarding the type of therapy at 48 weeks follow up (P <0.001). For clinical remission at 48 weeks, 29.3% of UC patients (61 out of 208) and 50% of CD patients (11 out of 22) achieved remission, with the difference being statistically significant (χ² = 3.954, P = 0.046). Conclusions: Biological therapies, particularly anti-TNF agents and Ustekinumab, were more effective in achieving endoscopic remission. Ustekinumab demonstrated superiority over anti-TNF agents as there were no recorded complications associated with it, while conventional treatments led to higher steroid dependence.