BACKGROUND: The pathophysiology of inflammatory bowel diseases is not fully understood. In a staged model by the European Crohn's and Colitis Organization (ECCO) regarding disease development, it is assumed that there is a population at risk for manifestation of disease following subtle changes over time. OBJECTIVE: This work aims to summarize the current state of knowledge regarding the pathophysiology, prediction and prevention of chronic inflammatory bowel diseases. MATERIALS AND METHODS: Selective literature research via PubMed. RESULTS: Several genetic, biochemical, and microbiome scores have the potential to identify individuals at increased risk of developing inflammatory bowel disease, possibly up to a decade before onset. DISCUSSION: The growing knowledge regarding the pathogenesis of inflammatory bowel diseases makes prediction before disease onset a possible future diagnostic goal. Hypothetically, early changes before the disease manifests could be reversible and may be amenable to prevention programs.