The pathogenesis of inflammatory bowel disease (IBD) continues to be explored, with the emphasis on genetically determined host immune dysregulation as it applies to interactions with luminal bacteria. The role of endoscopic ultrasound in the evaluation of IBD continues to be studied. Recent advances in the evaluation of enterocutaneous fistulas have been made through the use of hydrogen peroxide to enhance definition of the fistula course and characteristics of the neighboring bowel, as evaluated by transabdominal ultrasound. Refinements have been made in the use and interpretation of the results of surveillance colonoscopy for detection of colorectal cancer and dysplasia in IBD, but a consistent approach still needs to be applied by individual practitioners. New data exist on the usefulness of methotrexate for maintenance of remission, while a lack of efficacy has been demonstrated for mesalamine in the prevention of postoperative recurrence. The role of anti-tumor necrosis factor (TNF) antibody therapy in the treatment of IBD continues to be investigated.