Background  Adherence to medications in inflammatory bowel disease is associated with a reduced risk of both relapse and colorectal cancer development in the long term. However, many patients are non-adherent to their prescribed treatment regimen.

Aim  To review and discuss the extent of medication non-adherence in inflammatory bowel disease patients, the predictors of non-adherence, and strategies for optimizing patient adherence.

Results  More than 40% of inflammatory bowel disease patients do not adhere to their medication and thus a significant number of patients are not receiving the full benefits from their treatment – that is, remission and disease maintenance. The causes of medication non-adherence are multi-factorial. Improving medication adherence in patients is an important challenge for physicians; understanding the different patient types, the reasons given by patients for non-adherence and the predictors of non-adherence will help devise suitable plans to optimize patient adherence. Approaches such as improving the physician–patient relationship, individualized therapy, providing patient information and support, self-management programmes and practical aide memoires can be beneficial.

Conclusions  Implementation of strategies to improve medication adherence in inflammatory bowel disease patients increases the likelihood of patients achieving disease remission and maintaining remission in the long term, thereby improving symptom control and quality of life.