Inflammatory bowel disease (IBD) is widely recognized as a condition that progressively worsens, leading to ongoing and increasing damage to the bowel [1,2]. There is a growing consensus that early, personalized treatments aimed at specific goals can prevent this bowel damage and the associated physical disability in IBD. However, it is still uncertain what the best targets for these treatments are. The ideal target should be (1) well-defined, (2) achievable with current treatments, and (3) linked to positive long-term outcomes [3]. Previously, clinical remission was the goal, but with the development of effective biological treatments, the focus has shifted towards achieving endoscopic healing [4]. Questions have arisen about the benefits of aiming for even deeper healing, including histological and transmural healing. Technological advancements, like fecal calprotectin tests [5] and bedside cross-sectional imaging [6], have further supported this shift from just managing symptoms to normalizing objective signs of gut inflammation. While many observational studies suggest that deeper healing correlates with better outcomes, randomized controlled trials (RCTs) are needed to prove that treating to achieve these specific endpoints leads to meaningful clinical results. Additionally, proving that an extended treatment goal is superior isn’t enough to adopt it; the significant additional benefits of this new goal, compared to previous ones, must outweigh the extra costs and risks involved in achieving it. Choosing the most appropriate targets is challenging due to the limited number of RCTs examining the balance between cost, safety, and effectiveness.