Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • nil

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Regional health networks 

Exclusions

  • problems related to non-adherence to the recommended gluten free diet, refer to Dietetics

Triage categories

Category 1 — appointment clinically indicated within 30 days

  • new positive coeliac serology regardless of other symptoms or lack thereof
  • known coeliac disease with unexplained weight loss ≥ 10% in previous 3 to 6 months
  • dermatitis herpetiformis (for coeliac diagnosis exclusion with duodenal biopsy)

Category 2 — appointment clinically indicated within 90 days

  • review of continuing or recurrent symptoms
  • repeat biopsy to document response to gluten free diet (with negative coeliac serology)

Category 3 — appointment clinically indicated within 365 days

  • nil

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

History

  • symptoms
  • dietary and weight history
  • complete list of medications - including over the counter (OTC) medications
  • personal history of auto-immune diseases
  • family history of coeliac disease or other auto-immune diseases

Examination

  • complete blood examination (CBE)
  • urea, electrolytes, creatinine (UEC)
  • liver function tests (LFTs)
  • iron studies
  • vitamin D
  • vitamin B12
  • coeliac serology (anti-deamidated gliadin antibodies, anti-deamidated gliadin IgG) with titre

Investigations

  • all relevant previous imaging, endoscopic, histology reports

Additional information to assist triage categorisation

  • thyroid stimulating hormone (TSH)
  • serum or red cell folate

Clinical management advice

Please contact the Gastroenterology Registrar on call for clinical advice via switchboard.

Most referrals will be to help establish a new diagnosis or to assist with refractory symptoms despite a gluten free diet.

For people undergoing investigations for coeliac disease:

  • explain that any test is accurate only if a gluten containing diet is eaten during the diagnostic process and
  • advise the person not to start a gluten free diet until diagnosis is confirmed by a specialist, even if the results of a serological test are positive.

Positive coeliac serology: anti-tissue transglutaminase or anti-deamidated gliadin antibodies (tTg-IgA) and anti-deamidated gliadin immunoglobulin (IgG) (dGLI-IgG).

Coeliac serology should be performed following a gluten challenge of at least six weeks of daily gluten consumption (equivalent to four or more slices daily of gluten-containing bread).

If positive, a gluten containing diet should continue until a biopsy is performed, see Facilitated Access Gastroscopy CPC.

Positive HLA-DQ2/DQ8 genotyping should not be performed as it is not contributory to a diagnosis of coeliac disease.

Note that after diagnosis and adoption of a gluten free diet, almost all management of coeliac disease can be undertaken in the community by a General Practitioner (GP), patient and dietitian working together – supported by advice from the Coeliac Australia and HealthPathways (log in required).

If you are concerned that your patient requires specialist review, but the referral is declined, you are encouraged to contact the triaging clinician or Gastroenterology Registrar on call to discuss your concerns.

If a patient has been fully investigated within last 2 years and symptoms remain unchanged, clinician discretion is needed to appropriately refer and triage. In general, there is little value in repeat specialist assessment and/or endoscopic procedures in this scenario.

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

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.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.