Core tip: The efficacy of anti-tumour necrosis factor-α biologics has validated the role of inflammatory cytokines in the exacerbation of inflammatory bowel disease (IBD). However, inflammatory cytokines are released by patients’ own cellular elements including myeloid lineage leucocytes, which in patients with IBD are elevated with activation behaviour. Accordingly, these leucocytes appear logical targets of therapy and can be depleted by adsorptive granulocyte/monocyte apheresis (GMA). Therefore, in patients with IBD, there is a scope for removing from the body the sources of pro-inflammatory cytokines, and this should fulfill the desire to treat without drugs. Therefore, by introducing GMA at an early stage following the onset of IBD or before patients develop extensive mucosal damage, many patients should respond to GMA and avoid pharmacologics.