While 5-ASA and corticosteroids are still the mainstay of treatment, more potent immunosuppressive agents should be considered in refractory and steroid dependant patients not amenable to surgery. The activity and side effect profile of 6-MP/azathioprine, methotrexate and cyclosporine are now well established. Other agents such as mycophenolaat-mophetil, FK 506 and combination therapies may provide additional benefits in the future. Advances in the field of mucosal immunology have prompted interest in more specific immunologic approaches. Recombinant genetic engineering techniques enable us to test cytokines, anti cytokines, anti adhesion molecules etc. some of which with very promising clinical results. More data on long term safety and specific indications should be awaited before broader use of these agents can be advocated. An updated review is given from the current immunological based treatment modalities for both Crohn's disease and ulcerative colitis.