Infliximab is a chimeric monoclonal antibody to human tumor necrosis factor alpha. While its use was developed in the treatment of rheumatologic diseases its effects on Crohn’s disease have revolutionized the management of this chronic illness. Infliximab has effects on both immune and epithelial cells leading to a reduction in gut inflammation and collagen deposition which promotes wound healing. Large randomized trials have proven efficacy of the drug in luminal and fistulizing Crohn’s disease. Over time our understanding of antibody formation and long-term tolerability of the drug have refined our use of infliximab, eliminating episodic dosing and utilizing concomitant immunomodulator therapy to improve efficacy. Questions remain regarding top-down strategies, length of therapy, cost, reduction in surgical procedures, and the determination of which patients will respond best to any strategy chosen.