Question: A 49-year-old man presented with symptoms of retrosternal discomfort and mild dysphagia to solids. He had a 30-year history of ileocolonic Crohn’s disease requiring previous resections of the ileum and sigmoid colon. Clinical remission had been achieved with adalimumab and azathioprine combination therapy, with the subsequent decision to de-escalate to maintenance with azathioprine monotherapy after consideration of the risks and benefits of dual immunosuppression. After 5 years of azathioprine monotherapy, complete endoscopic remission was reconfirmed at a recent ileocolonoscopy.