In the diagnosis of inflammatory bowel disease (IBD), careful history taking based upon available epidemiological data, along with judicious use of biochemical and bacteriological examination is the most powerful and cost-effective technology, particularly to rule out irritable bowel syndrome (IBS). We also have to be careful in evaluating symptomatic IBD patients looking for exacerbating factors such as Clostridium difficile infection, use of NSAIDs, and non-adherence which is revealed only by frank discussion.