Ramadan fasting may induce changes in gastrointestinal physiology. The effect of this fasting on inflammatory bowel disease (IBD) is not known. We conducted a cohort study in the month of Ramadan in 2006 to assess the effect of Ramadan fasting on IBD. Sixty patients with IBD, who were in remission and undertook fasting according to their own free will underwent assessment of quality-of-life (QoL) parameters, psychological state and the severity of symptoms before and after Ramadan. There was no correlation between the number of fasting days and the severity of the disease, QoL and psychological state of the patients. QoL did not change after Ramadan. Younger patients with ulcerative colitis (UC) fasted for a greater number of days (p=0.01) compared to older patients. The mean score of anxiety, using a modified version of the Hospital Anxiety and Depression Scale was 12.7 (6.0) before Ramadan in women with UC, and decreased to 9.8 (4.4) afterfasting (p=0.026). Men with UC had a mean score of colitis activity index of 3.5 before Ramadan, which decreased to 1.7 after fasting (p=0.008). It appears that Ramadan fasting does not impose serious risks on patients with IBD.