BACKGROUND: Currently, medical therapy of Crohn's disease (CD) can reduce the progression of some forms of structural bowel damage (SBD), but it does not prevent it. Once SBD has developed, it is important to assess the potential of medical treatments to reverse this damage. AIMS: To determine whether transmural healing (TH), assessed by intestinal ultrasonography (IUS), can be achieved with medical treatment in CD patients with SBD compared to those without. METHODS: A prospective, longitudinal, observational study was conducted to compare IUS monitoring at 3 and 12 months of treatment between CD patients with SBD prior to treatment and those with an inflammatory pattern. RESULTS: Three months after starting treatment, patients without SBD had a significantly higher TH rate than those with SBD (25.8% vs 7.8%, respectively; P = .004). However, after 12 months, the TH rate was not significantly higher in patients without SBD compared to those with SBD (34% vs 26.6%, respectively; P = .317). During these 12 months, the need for corticosteroids, hospitalizations, and surgical resection was significantly higher in the SBD group. CONCLUSIONS: Biological treatment can reverse SBD in CD, but hospitalizations and surgery rates remain higher in this group.