OBJECTIVES: Inflammatory Bowel Diseases (IBD), which include Crohn’s disease and Ulcerative Colitis, are chronic and life-long conditions. Only symptomatic reliefs exist, because the exact cause is not entirely understood. The aim of this study was to analyze the healthcare profile and the overall cost of patients with IBD in the real clinical practice. METHODS: From ARNO Observatory database we carried out a record linkage analysis of disease exemptions, drug prescriptions and hospital discharges on 2.664.778 subjects, with available, complete and good quality data. Hospitalizations and specialist services of every single patient with IBD were followed up to 3 years after the accrual (from 01/01/2009 to 31/12/2009), while pharmaceutical data were collected up to 4 years. All pharmaceutical prescriptions, hospital care (re-hospitalizations, gastro-intestinal surgery, in-hospital mortality), diagnostic procedures and their costs (mean patient/year) were analyzed. RESULTS: CONCLUSIONS: In-hospital cares are the main cost driver for patients with IBD. This must be considered by LHUs and Physicians when evaluating patient healthcare pathways with chronic disease and estimating costs of illness. ARNO Observatory represents an important tool to support clinical governance.