In recent years, novel oral medications have become available for the management of inflammatory bowel diseases (IBD). These small molecule drugs (SMD) selectively target aspects of the immunological pathways that drive intestinal inflammation in IBD and offer alternatives to biological treatments. Tofacitinib, Filgotinib and Upadacitinib inhibit Janus kinases (JAKs), which are enzymes involved in the signalling pathways that mediate inflammation. Ozanimod and etrasimod modulate sphingosine 1 phosphate (S1P) receptors, thereby reducing lymphocyte migration to inflammatory sites in the gut. Currently, these agents are licensed for the induction and maintenance of remission in moderate-to-severe ulcerative colitis (UC, all agents) and Crohn’s disease (CD, upadacitinib only). Small molecules in IBD enhance the therapeutic landscape. Patients may prefer the oral administration of small molecules over biological antibodies. These drugs typically have a fast onset of action and no immunogenicity, reducing the risk of immune reactions. The efficacy is likely dose related, as is the risk of side effects. Unlike biologic drugs which are specific for a given epitope target, small molecules have selective efficacy at blocking their target, and this selectivity may broaden with dose.