The incidence and prevalence of IBD increase in our Western populations. Standard therapy with glucocorticosteroids and 5-ASA formulations allow control in only about half of the patients with substantial toxicity for the former drug. Since it became apparent that both UC and Crohn's disease are disorders mediated through abnormalities in the mucosal immune system immunosuppression and immunomodulation have become current practice in the treatment of refractory IBD. In UC cyclosporin is the main immunosuppressive agent. In Crohn's disease azathioprine is the mainstay of therapy for refractory disease. Recently anti-TNF strategies have been developed which hold great promise for the treatment of Crohn's disease.