It is well accepted that Crohn’s disease is associated with a small but real risk of death. Population based reports from Sweden,^1,2 Denmark,³ and Italy⁴ indicate that Crohn’s disease patients have a higher mortality rate than expected, although at least one notable exception from the UK demonstrated survival similar to the general population (table 1).⁵ A preliminary report from Olmsted County, Minnesota, indicated a mortality rate that was about 20% higher (but not significantly different statistically) than that expected,⁶ standing in contrast with the results of a previous report from the same location.⁷ The largest study of mortality in Crohn’s disease was from a cohort of approximately 6000 patients identified through the General Practice Research Database (GPRD), which contains the computerised medical records of 6% of the British population.⁸ The annual mortality rate in Crohn’s disease was 1.6% compared with 1.0% in age, sex, and practice matched controls. After adjusting for age, sex, and cigarette smoking, it appeared that the risk of death was 73% higher in Crohn’s disease patients than in controls.⁸ Although the large cohort size makes this study important, its generalisability is limited by the fact that the cohort was a mixture of incidence and prevalence cases, the average age at entry into the cohort was 42 years (higher than the average age at diagnosis of Crohn’s disease of late 20s/early 30s in most studies), and the average follow up was only three years. A recent systematic review of “hard end points” in population based cohorts of Crohn’s disease concluded that there was no evidence for a significant change in disease outcome over the past 40 years.⁹ To summarise, …