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Introduction: Inflammatory bowel disease (IBD) is usually diagnosed when symptomatic. Prognosis and evolution of preclinical IBD is largely unknown. However, colorectal cancer screening programs (CRCSP) detect a subset of IBD patients with no symptoms. The aim of this study is to describe the natural history of asymptomatic IBD diagnosed through CRCSP., Methods: An observational, longitudinal and retrospective study was performed at 22 centres in Catalonia between January 2010 and December 2019 including patients with asymptomatic IBD detected in the CRCSP. Demographic data and IBD characteristics, evolution and treatment were recorded. Descriptive statistics and Kaplan-Meier analysis were used for the analysis. Data were given separately for IBD, Crohn's disease (CD), ulcerative colitis (UC) and IBD unclassified (IBDU)., Results: One hundred and eighty-eight patients were included: 103 UC (54.8%), 60 CD (31.9%) and 25 IBDU (13.3%). Sixty-six (35.1%) were women and the average age was 59.9 ± 5.9 years. Sixty-four patients (34.0%) developed symptoms after a median follow-up of 35.6 months. Diarrhoea was the most frequent symptom for CD and IBDU (25.4% and 11.5% respectively) and blood in stools for UC (21.4%). Median time to first symptom was 11.6 months. Treatment was prescribed in 135 patients (72.2%); mesalazine was the most prescribed drug (123 patients; 65.4%). Thirteen patients (6.9%) required biological treatment. None underwent surgery., Conclusion: Around one-third of asymptomatic IBD patients developed symptoms after a medium follow-up of 3 years. Only 6.9% required biological treatment and none required surgery. Overall, prognosis of asymptomatic IBD seems better., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)