Entering the era of disease modification in Crohn's disease.

INTRODUCTION: Crohn's disease (CD) can follow a progressive course leading to structural bowel damage and disability. The expansion of advanced therapies and recognition of a window of opportunity have shifted management from symptom control toward disease modification. AREAS COVERED: After searching MEDLINE and Embase from inception until 1 July 2027, we reviewed studies examining early intervention and disease modification in Crohn's disease. This review examines evidence for early medical and surgical intervention as individual treatment strategies to modify the course of disease, distinguishes short-term inflammatory control from durable alteration of disease course, and considers emerging strategies that target fibromuscular remodeling. We also address the heterogeneity of CD, the aspirations for precision approaches, and the challenges of implementing timely, personalized care. EXPERT OPINION: Early intervention and disease modification have evolved over time in Crohn's disease and that there is now a robust evidence-base to support the potential for disease modification in Crohn's disease, particularly with initiation of early effective intervention as soon as possible after diagnosis. Given the successes of early intervention, there is now increasing focus on the potential for preclinical intervention as a means to potentially prevent disease onset, reduce cumulative bowel damage, and avoid long-term disability.