In rheumatoid arthritis, which shares some common aetiological pathways and treatments with Crohn disease, treatment goals no longer include symptom control alone, but also alteration of the biological processes underlying synovial inflammation and progressive structural destruction, thereby preventing structural joint damage and functional decline.1 Analogous disease-modifying treatment goals for Crohn disease are currently being conceptualised and may include prevention of structural bowel damage (stricture, fistula, abscess) and impaired gastrointestinal physiology (ie, maintaining normal gastrointestinal physiology).2 3