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Background: It has been suggested that inflammatory bowel disease (IBD) has a milder course in Greece than in other Western countries. The purpose of our study was to assess the clinical picture of IBD in a hospital-based sample of IBD patients, followed from January 1986 to May 2001., Material/methods: Retrospective study of 172 patients: 130 with UC followed up for 1-360 months (mean 66+/-57 months) and 42 with CD for 1-240 months (mean: 51.85+/-63.68 months)., Results: 63 UC patients (48%) required hospitalization, 30 (23%) on the first attack; 72 (55%) had left sided colitis and 23 (18%) pancolitis; in 6 cases, (5%), surgical intervention was indicated at onset, 4 (3%) were operated. During FU, 15 patients (11.5%) were operated, 4 (3%) as medical emergencies, 3 (2%) due to colon cancer, the others for intractable colitis or long-standing disease; 5 patients (4%) developed toxic dilation of the colon, 3 (2%) developed colon cancer and 4 (4%) extraintestinal malignancies. 7 patients (5%) died; 2 (1.5%) due to the disease and the remainder for other causes. 19 CD patients (45%) had ileocolitis and 14 (33%) colitis; 22 (52%) needed hospitalization on the first attack. In 12 patients (29%) surgical intervention was required on initial onset or during FU. One patient developed colon cancer (2%). Two men died (5%) from myocardial infarction., Conclusions: IBD does not have a milder course in Greece than in other European populations.