Objective: The Inflammatory Bowel Disease Questionnaire (IBDQ) is a valid, reliable, and sensitive measure to assess patients' subjective health status and quality of life (QOL). Prior to its use in an international clinical trial of active Ulcerative Colitis, the 32-item IBDQ underwent linguistic validation in 35 languages or cultures, including 8 Indian languages. Methods: For languages with no prior translation, the Canadian English original was translated by specialists in each target country following a standardized methodology: 1) two independent forward translations were done by professional translators, native speakers of the target language and fluent in English; 2) comparison with the original and reconciliation of translations by the target country specialist were made; 3) backward translation was performed by a native English speaker; 4) comparison of source and backtranslations were reviewed with the IBDQ developer; 5) comprehension testing of 5 patients with moderately to severely active Ulcerative Colitis was performed. Pre-existing translations were integrated into the process as appropriate. Results: Linguistic and conceptual challenges emerged in translating the 7-point Likert scale response choices (RC). Literal translation of the original 7-point RCs was not suitable in all languages. Anchors were chosen to be comparable to the original; the five middle response choices were logical and equidistant from one another. Some wording adaptation was needed for most countries to reflect local idiomatic expressions; particularly, “bowel movements” required more precise translation in most languages. Conclusion: The 35 language versions of the IBDQ were established using a rigorous process to ensure conceptual harmonization that would permit international comparisons and data pooling. The IBDQ may now be used confidently in these countries to evaluate the impact of inflammatory bowel disease on patients' daily lives.