Coeliac Disease
Adult

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Emergency Referrals

Useful Management Information

Refer to HealthPathways for assessment and management recommendations.
Consider the following:
- Referral to Dietitian:
  - do not remove gluten prior to diagnostic testing or endoscopy, as this may affect results.
  - once diagnosis is confirmed, refer the patient to a dietitian experienced in gastrointestinal/coeliac disease management for:
  - education on a strict gluten-free diet
  - ongoing monitoring of adherence and nutritional adequacy
  - individualised education should be provided if there are concerns regarding adherence or nutritional management.
Screen family members with serology (1 in 10 chance in immediate family members)
Baseline bone mineral densitometry in all adults (those with medically diagnosed coeliac disease are entitled to a Medicare rebate).
Monitor for other auto-immune disorders
Expanded nutrient testing e.g. magnesium, zinc, calcium and copper are not routine but should be considered if malabsorption is suspected.
Immunisations:
- Annual influenza, COVID-19 and against pneumococcus is recommended.
- Vaccination against the other main encapsulated bacteria Neisseria meningitidis and Haemophilus influenzae type B should be considered

Note: If the patient is already following a gluten-free diet, advise that a gluten challenge may be required prior to diagnostic testing (typically 8–10 g of gluten per day for 6 weeks). If the patient is not on a gluten-free diet, recommend avoiding dietary changes until diagnostic confirmation has been completed.

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	New diagnosis Positive coeliac serology with concerning features: ≥5% unintentional weight loss (6 months) gastrointestinal bleeding iron deficiency (as defined) persistent vomiting dysphagia/odynophagia (where relevant) abnormal imaging or mass diarrhoea significantly impacting on activities of daily living bloody or nocturnal diarrhoea persistent unexplained abdominal pain micronutrient deficiencies (iron, vitamin B12, folate) Previously confirmed diagnosis Serological titres persistently elevated or show little change after ≥12 months of confirmed strict gluten free diet. New onset of any of the above-described ‘concerning features’ after previous improvement on a strict gluten free diet. Note:Referrals for conditions such as coeliac disease should be directed through the most clinically appropriate pathway. This may include a complementary care pathway, a Dietitian First gastroenterology clinic pathway. The triage process should be guided by the patient’s predominant clinical features, the suspected underlying cause, and the investigations or interventions most likely to be required. In some Hospital and Health Services (HHSs), patients may be considered for an initial assessment by a Dietitian, either before or instead of being referred to Gastroenterology. This approach supports appropriate and timely referrals to the most suitable pathway, ensuring patients receive the care that best addresses their specific needs.
Category 2 (appointment within 90 calendar days)	New positive coeliac serology without concerning features requiring endoscopic confirmation: Diarrhoea significantly impacting on activities of daily living Bloody or nocturnal diarrhoea Unexplained weight loss, ≥5% of body weight in <6 months Persistent unexplained abdominal pain Micronutrient deficiencies (iron, vitamin B12, folate) Previous diagnosis of coeliac disease without any concerning features requiring follow-up Suspected diagnosis in patients without other explanation for micronutrient deficiencies (e.g. iron deficiency, folate or vitamin B12) or extraintestinal findings (e.g. dermatitis herpetiformis, recurrent foetal loss, persistent aphthous stomatitis, metabolic bone disease, peripheral neuropathy). Note: Referrals for conditions such as coeliac disease should be directed through the most clinically appropriate pathway. This may include a complementary care pathway, a Dietitian First gastroenterology clinic pathway. The triage process should be guided by the patient’s predominant clinical features, the suspected underlying cause, and the investigations or interventions most likely to be required. In some Hospital and Health Services (HHSs), patients may be considered for an initial assessment by a Dietitian, either before or instead of being referred to Gastroenterology. This approach supports appropriate and timely referrals to the most suitable pathway, ensuring patients receive the care that best addresses their specific needs
Category 3 (appointment within 365 calendar days)	Known coeliac disease without symptoms or abnormal pathology requiring routine review or surveillance endoscopy Note: Referrals for conditions such as coeliac disease should be directed through the most clinically appropriate pathway. This may include a complementary care pathway, a Dietitian First gastroenterology clinic pathway. The triage process should be guided by the patient’s predominant clinical features, the suspected underlying cause, and the investigations or interventions most likely to be required. In some Hospital and Health Services (HHSs), patients may be considered for an initial assessment by a Dietitian, either before or instead of being referred to Gastroenterology. This approach supports appropriate and timely referrals to the most suitable pathway, ensuring patients receive the care that best addresses their specific needs
If your patient does not meet the minimum referral criteria Assessment and management information may be found on a range of conditions at HealthPathways If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.) Please note that your referral may not be accepted or may be redirected to another service

Standard Referral Information

Reason for request

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can't order, or the patient can't afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
All conservative options that have been pursued unsuccessfully prior to referral
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

Willingness to have surgery (where surgery is a likely intervention)
Choice to be treated as a public or private patient
Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Essential Referral Information

FBC, ELFT, iron studies
Previously positive serology results or biopsy results (if applicable).
Transglutaminase-IgA (tTG-IgA) antibody test AND the total IgA level (to exclude the 2-3% of people with coeliac disease who are IgA deficient).

Additional Referral Information

HLA DQ2 and HLA DQ8 genetic testing if serology negative/inconclusive and patient unable to or reluctant to complete gluten challenge*.
TSH, Vitamin B12, Folate, Vitamin D
Bone mineral density scan results

*Genetic testing investigations provide valuable diagnostic information but may not be covered by Medicare and could incur an out-of-pocket cost to the patient. These tests are recommended where clinically appropriate; however, completion should be based on informed patient choice following discussion with the referring clinician.

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Medical Objects Account: GQ42150009Z

HealthLink EDI: Qldgchsd

Internal Referrals

Endoscopy qhRefer

Fax

(07) 5687 4497

Post

Booking and Referral Centre
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

1300 559 083

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Dr Sneha John

Medical Director Endoscopy

Facilities

Gold Coast University Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Coeliac DiseaseAdult