Inflammatory bowel disease (IBD) was not common in Asia a couple decades ago. The incidence of IBD is increasing rapidly in recent years. A population-based epidemiologic study in Asia showed that the incidence of IBD varied from 0.60 to 3.44 per 100 000. From 2013 to 2018, the hospitalization rates for Crohn’s disease (CD) and ulcerative colitis (UC) in China increased from 2.20 (95% CI: 2.17–2.22) to 3.62 (3.59–3.65) per 100,000 inhabitants (P<0.0001) with an annual percentage of change （APC） of 10.68 (6.00–15.36)% and from 6.24 (6.20–6.28) to 8.29 (8.23–8.33) per 100,000 inhabitants (P<0.0001) with an APC of 5.73 (2.32–9.15)%, respectively. UC is more prevalent than CD, but CD incidence is rapidly increasing. Stricture and penetrating CD are common in Asia. These epidemiologic changes may relate to increased contact with the westernization of diet, improved hygiene, increasing antibiotics use, or changes in the gut microbiota. Results from a population-based case control study showed breast-feeding, having pets, sharing bed in the childhood were protective of IBD, suggesting that environment plays an important role in etiology. Research in Asia, an area of rapidly changing IBD epidemiology, may lead to the discovery of critical etiologic factors that lead to the development of IBD.