Inflammatory bowel disease is a progressive and debilitating condition. Early and effective treatment utilizing a treat to target approach is key in improving patient outcomes. Therefore, proactive monitoring is essential to ensure treatment strategies are working and targets are being met. In this review we discuss the current monitoring tools available to us and how they can be utilized. We also discuss the importance of monitoring during key phases of the disease and propose an optimum treat to target monitoring strategy for Crohn’s disease and ulcerative colitis.