This paper presents a review of 64 patients in whom the first symptoms of inflammatory bowel disease occurred after the age of 60 years. Inflammatory bowel disease in older patients affects the large bowel much more commonly than the small bowel. The commonest variant is disease localized in the rectum and distal colon, and many of these patients have Crohn's disease (14 out of 28 patients). In 19 patients with localized left-sided colitis it was difficult to distinguish ischaemic colitis, acute diverticulitis and Crohn's disease. Patients with left-sided colitis or total colitis (15 patients) had a high incidence of acute complications, particularly colonic perforation. There should be an awareness of the risks associated with all types of colitis in the older patient.