Polydimethylsiloxane (PDMS) silicone elastomer is extensively used in soft lithography processes to fabricate microscale or nano scale systems for microfluidic or cell culture applications. Though PDMS is biocompatible, it is not an ideal material for cell culture due to its poor cell adhesion properties. In this study, PDMS surfaces were modified to promote intestinal cell adhesion, in the interest of testing feasibility of using microfabricated PDMS systems for high throughput drug screening. Modification techniques included changing chemical composition of PDMS (i.e., varying curing to mixing agent ratio, and oxidization of PDMS surface by oxygen plasma), surface treatment of PDMS by coating with charged molecules (i.e., poly‐D‐lysine, L‐α‐phosphatidylcholine, and a layer bylayer coating), and deposition of extracellular matrix (ECM) proteins (i.e., laminin, fibronectin, and collagen). The influence of these modifications on PDMS properties, including elastic modulus and surface properties (wettability, chemical composition, topography, and protein adsorption) were characterized. Modification techniques were all found to change PDMS properties and influence the attachment and proliferation of Caco‐2 cells over three days of culture to varying degrees. Generally, Caco‐2 cells preferred to attach on collagen‐coated, fibronectin‐coated, and fibronectin‐coated oxygen‐plasma treated PDMS. The results highlight the importance of considering multiple physical and chemical factors that may be influenced by biomaterial modification and result in altered cell attachment to microfabricated systems, including surface hydrophobicity, chemical composition, stiffness, and topography. This study provides a foundation for further miniaturization, utilizing soft lithography techniques, of Caco‐2 cell‐based system for high‐throughput screening of drug intestinal absorption during lead optimization in drug discovery. The understanding of different surface modifications on adjusting cell adhesion on PDMS allows systemic design of Biomicroelectromechanical Systems (BioMEMS) with tunable cell adhesion properties. © 2009 Wiley Periodicals, Inc. J Biomed Mater Res 2010