Coeliac disease is increasingly easily diagnosed now that tissue transglutaminase immunoglobulin A (IgA ) antibody assays are widely available and their use understood. As many patients have relatively mild or non-specific symptoms, and the population prevalence is about 1%, it is important to have a clear understanding of the frequency of the complications of the condition. This allows the impact of the diagnosis to be explained, and appropriate therapies in addition to a gluten-free diet to be given.

The long-term risks in coeliacs have been clarified recently with large population studies, using the UK GP research database and the Swedish national inpatient register. The relative and absolute risks are now much clearer for the complications that have been recognised for a long time, such as malignancy, lymphoma and fracture.1^–4 Other risks such as liver disease and pancreatitis are now apparent from large population studies. In this issue, Ludvigsson and colleagues5 report on the risk of sepsis in >15 000 coeliacs included in the Swedish inpatient register between 1964 and 2003 (page 1074).

When compared with an inpatient reference population, a hazard ratio of 1.6 (95% CI 1.2 to 1.9, p<0.001) was found for any diagnosis of sepsis in coeliacs. Pneumococcal sepsis had a higher risk, with a hazard ratio of 2.5 (95% …