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Biologics have completely changed the treatment (and life) of patients with inflammatory bowel disease (IBD). After the first ones, anti-tumor necrosis factor (TNF) biologics, two new biologics, with other therapeutic targets, are now in routine use in our patients, and some others are in different stages of research. They share many aspects, but differ in others, so their efficacy and safety may be different. Having predictors of efficacy and safety in a particular patient are one of the greatest challenges in IBD therapy, but we are far from achieving it. In any case, safety is key, especially in drugs used as maintenance therapy in a chronic disease such as IBD. Although biologics are generally safe when are used correctly, it is essential to be aware of their potential adverse events and their particularities in different situations. To minimize them, it is essential to use them in the ideal patient, to choose the right biologic at the right time, to carry out a series of prior measures before start them, and, finally, to monitor the treatment correctly. We will discuss the differences between biologics, essentially anti-TNF versus ustekinumab versus vedolizumab, in terms of adverse events as well as their particularities of use. Having the knowledge of their contraindications, use in special populations, the steps before start, and how to monitoring them is essential. Although sometimes there are alternatives to biologics such as “the new small molecules,” they are not the purpose of this review.

Resumen: Contexto: Presentamos un caso de ingestión accidental de sosa cáustica, se trata de un caso infrecuente dado que normalmente se relaciona con suicidios y autolesiones, siendo estos últimos de peor pronóstico. Presentación del caso: Varón de 92 años con deterioro cognitivo leve-moderado atendido en su domicilio tras la ingesta accidental de una cucharada de sosa cáustica.El paciente presenta voz engolada, refiere dolor intenso en la lengua. Se le administra analgesia e inhibidores de bomba de protones y se le traslada al hospital de referencia. Conclusiones: La sosa caustica o hidróxido sódico es un agente cáustico alcalino que provoca lesiones de la mucosa, úlceras, exudados o necrosis.La extensión de las lesiones depende de varios factores como son la cantidad de sustancia ingerida, la duración del contacto y la concentración del agente cáustico.Un manejo inicial adecuado es clave para la disminución de las tasas de morbimortalidad. Abstract: Context: A case is presented of accidental ingestion of caustic soda. This is an unusual case, since it is normally related to suicides and self-harm, the latter being of worse prognosis. Presentation of the case: A 92-year-old male with mild-moderate cognitive impairment treated at home after accidental ingestion of a tablespoon of caustic soda.The patient has a slurred voice and reported intense pain on his tongue. He was given analgesia and proton pump inhibitors and then transferred to the referral hospital. Conclusions: Caustic soda or sodium hydroxide is an alkaline caustic agent that causes mucosal lesions, ulcers, exudates, or necrosis.The extent of the injury depends on several factors such as the amount of substance ingested, the duration of contact, and the concentration of the caustic agent.Proper initial management is key to reducing morbidity and mortality rates.