The management of the inflammatory bowel diseases (IBD), Crohn's disease and ulcerative colitis, has been revolutionised in the last decade by the availability of efficacious medical therapies and by the adoption of effective new treatment strategies utilising these agents. The most effective medical therapies are immunomodulators (thiopurines and methotrexate) and biologic agents (anti-tumour necrosis factor agents and adhesion molecule inhibitors), often used in combination. The most significant advance in treatment strategy has been the gradual adoption of a treat-to target approach in which treatment goals extend beyond symptom control to the objective normalisation of inflammatory biomarkers. This means that patients are asked to undergo regularly scheduled investigations to assess the activity of their disease. Although colonoscopy remains the gold-standard investigation in IBD it is invasive, costly and carries small risks. Therefore, non-invasive investigations to monitor disease activity in IBD are required and have been developed in recent years; these include fecal tests and intestinal ultrasound. Fecal tests measure calprotectin, a protein in neutrophils in the gastrointestinal tract for which the sensitivity and specificity of measuring intestinal inflammation is high, especially for colonic disease. Fecal calprotectin tests are cumbersome, not popular with patients, and not currently reimbursed by Medicare, costing patients ? $85/test ñ during periods of active disease these may need to be repeated 3-6 monthly. Intestinal ultrasound has emerged as a highly accurate and practical means of performing tight disease monitoring in IBD in the last 5 years. Although it was initially used predominantly for small bowel disease, accuracy for colonic disease is also excellent, meaning it is useful for both Crohn's disease and ulcerative colitis. There is no need for fasting nor bowel preparation, there is minimal if any discomfort, the tests is easily repeated and results are available immediately, making it popular with patients. Ongoing research is required to establish definitions of sonographic remission that should become treatment targets. The adoption of intestinal ultrasound into treat-to-target IBD management algorithms has been enthusiastically welcomed by gastroenterologists; it is anticipated that this trend will continue in coming years.