Background: the course of inflammatory bowel diseases (ibd) has mainly been studied using different methods in single patient cohorts. The aim of the present study was to assess clinical aspects of disease outcome in a population-based cohort of ibd patients over a 4-year period in multiple centres across europe. Methods: a total of 796 patients with ibd diagnosed in 10 centres between october 1991 and october 1993, registered at the ec ibd study centre (98% of the original cohort), participated in the study. Investigators filled out a standard follow-up form containing questions on the method of follow-up, vital status of the patient, change in diagnosis, extraintestinal manifestations, medical and surgical treatment, and physician's global assessment of disease activity. Results: complete relief of the complaints was reported in 255 (48%) patients with ulcerative colitis (uc), 9 (50%) with indeterminate colitis (ic), but only in 87 (35%) of patients with crohn disease (cd). Improvement was reported in 195 (37%) patients with uc, 113 (45%) with cd and 6 (33%) with ic. During the 4-year follow-up period, 23 patients died (14 uc, 8 cd, and 1 ic). The mean age at death was 69.3 years (s, 14.9 years). The deaths of three patients were recorded as directly due to ibd. Conclusions: with the present approach to therapeutic management the short-term outcome of patients with ibd seems to be favourable in 10 medical centres in the north and south of europe. However, more detailed studies including both objective and subjective measures are necessary.