Targeted biological therapies have in one way revolutionized some chronic GI diseases. In other ways they have complicated the landscape, monitoring and management of the GI patient. The positive and negative aspects of these therapies will be discussed. Common drugs, adverse events and appropriate monitoring will be discussed. We will also discuss the methods used to assess safety and compatibility of natural agents and biological drugs. What specific agents are helpful, and can they improve and make safer the biological drug therapies?