A t present, despite the claims of promoters of new diag- nostic approaches, the diagnoses of Crohn's disease (CD) and ulcerative colitis (UC) depend on a combination of clinical, laboratory, radiographic, endoscopic, and histological criteria. Once these diagnoses are established by traditional means, it would be desirable to predict the clinical course and prognosis for an individual patient. There have been substantial advances in the development and commercialization of a number of serologic and genetic markers in patients with IBD. These markers have incrementally advanced our understanding of the underlying aberrant immune responses in patients with IBD, particularly in CD. Nonetheless, they have yet to be prospectively shown to be sufficiently sensitive and specific to inform a given patient of their future. We remain humbled by our insufficient skills when it comes to gazing into the crystal ball of prognosis. In this article we describe the case for the importance of accurate disease phenotyping by our traditional and time-tested clinical means. In addition, we will address the potential pitfalls in predicting clinical course of disease based on the currently available serologic and genetic markers.