In patients most at risk to have a disabling disease or to require surgery, active treatment with immunosuppressants or biologics should be discussed in balance with the goal of therapy, which may be different in a young adult searching for work and a retired individual. For example, ileocecal resection may be the preferred option in a young nonsmoker patient with a limited stricturing disease, because if unoperated on he will have a disabling course whereas surgery will probably give him several years of remission. On the other hand, in one CD patient with a severe clinical presentation, an ileocolonic location, a perianal disease, and current smoking, early surgery must be avoided and to achieve this, immunosuppressants and biologics should be started within the few weeks following diagnosis. In patients operated on but at high risk of postoperative recurrence, particularly in those with prior extensive or multiple resection, postoperative anti-TNF should be considered [144]. Moreover, during the disease course, high-risk patients should be checked regularly for the presence of intestinal ulcerations and thickening, using noninvasive techniques (CRP, ferritin, fecal calprotectin, video capsule, and MRI) and treated as early as possible with the goal to heal lesions before the disease expresses clinically.