Background: There are very few studies from South India about the epidemiology and clinical features of inflammatory bowel disease (IBD) exclusive to the region. This hospital based study was aimed to determine the clinical and epidemiological profile of IBD patients who had undergone in an apex tertiary gastroenterology centre in Madurai, South India. Material and Methods: 63 consecutive IBD patients were included in this cross sectional prospective observational study over a period of 18 months. Participants demographic and clinical profiles, disease activity, severity, extra intestinal manifestation, medical and surgical interventions and response to therapy were evaluated. Results: Of the 63 Inflammatory bowel disease cases, 24 had Crohn’s disease(CD) (38%) and 39 had Ulcerative colitis(UC) (62%). Most common age group of UC was in fourth decade while CD had bimodal incidence. Systemic symptoms in both groups were by and large the same with few exceptions. Most of the patients with IBD had low normal Body mass index(BMI) with evidence of nutritional deficiency in form of low haemoglobin and serum albumin. Extra-intestinal manifestations, though uncommon were seen in both groups, Most UC had left sided colitis(E1&E2) while ilecolonic disease was most common in CD (L3) patients. Most of patients achieved remission with initial treatment, [UC (82%) & CD (67%)]. However, a significant minority (8% of UC & 20% of CD) patients required surgical intervention. The use of biologicals and novel interventions still remains in the nascent stage. Conclusion: There is rise in prevalence of inflammatory bowel disease in south India. The clinical profile of IBD here concurs moreor less with similar studies published from other parts of the country. Though most of the patients responded well to the initial treatment, there is definite lacunae in the acceptance of novel medical and surgical interventions.