Background and aim: accurate diagnosis of inflammatory bowel disease (IBD) are mandatory steps for a good outcome. Its standard method for assessment is still ileo-colonoscopy; however, many recent reports described the utility of intestinal ultrasound (IUS) and duplex US in evaluating patients with IBD. We aimed to explore the efficacy of IUS and duplex US for the accurate diagnosis and follow-up of patients with IBD. Methods: The current study was performed for >2 years between September 2018 and September 2020. A total of 60 patients diagnosed with IBD and 51 control subjects who underwent colonoscopy for reasons other than IBD were included. The two groups underwent colonoscopy and IUS with Doppler for the diagnosis and follow-up of patients after 1 year of treatment. Results: The mean age of patients with IBD was 29.23 ± 5.62 years, and 56.7% of them were females. The majority of them presented with abdominal pain, diarrhea, and bleeding per rectum. Patients with IBD had significantly lower hemoglobin, iron, and ferritin levels with higher C-reactive protein and erythrocyte sedimentation rates. The IBD group had significantly higher wall thickness (WT), peak systolic velocity (PSV), and end-diastolic velocity (EDV). After 1 year, the IBD group showed a significant reduction of WT and PSV. The PSV had the best diagnostic performance for the prediction of histological and clinical responses. Conclusion: IUS and duplex US are considered rapid noninvasive tools for the assessment of patients with IBD. Moreover, they can be used to predict histological and clinical responses.