• Epidemiology
• Inflammatory bowel disease

We thank Newman et al 1 for the interest in our recent letter2; however, we strongly disagree with the statement that our work has ‘significant methodological flaws’. First, in regard to inference of sexual behaviour from billing codes, we would like to point out that prior studies have used these codes to analyse administrative datasets.3 We acknowledge the possibility of biases inherent to large database studies that use the electronic health record (EHR), including the potential for misdiagnoses, inaccurate coding and documentation errors. However, administrative claims documenting sexual orientation are coded by clinicians, the diagnoses relying on provision of patient-derived information and providers’ decisions, which can also be impacted by failure to divulge sexual activity, and may represent an important potential limitation for future prospective studies that should obviously be performed to either support or negate the current …