COX-2 specific anti-inflammatory agents appear as able to induce a flare of inflammatory bowel disease as classical anti-inflammatory agents. The use of steroids, immunomodulators or infliximab prior to surgery does not appear to increase post-operative complication rates. Cases of hepatitis B reactivation have been described after infliximab therapy, suggesting that hepatitis B serological status should be verified prior to infliximab therapy. Adalimubab, a fully humanized antibody directed against TNF-alpha, is efficacious in patients that have lost response or did not tolerate infliximab. Approval of this agent is still awaited. Leucoapheresis is a promising tool in ulcerative colitis.