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.
For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.
Central Adelaide Local Health Network
Northern Adelaide Local Health Network
- Lyell McEwin Hospital (08) 8182 9000
Southern Adelaide Local Health Network
Problems related to non-adherence to the recommended gluten free diet.
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)
- all other coeliac referrals
Category 3 — appointment clinically indicated within 365 days
For information on referral forms and how to import them, please view general referral information.
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.
- identifies as Aboriginal and/or Torres Strait Islander
- identify within your referral if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
- interpreter requirements
- dietary and weight history
- complete list of medications - including over the counter (OTC) medications
- family history of coeliac disease or other auto-immune diseases
- complete blood examination (CBE)
- urea, electrolytes, and creatinine (UEC)
- liver function tests (LFT)
- iron studies & vitamin D
- coeliac serology (anti-deamidated gliadin antibodies, anti-deamidated gliadin IgG)
- 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
Most referrals will be to help establish a new diagnosis or to assist with refractory symptoms despite a gluten free diet.
If a patient has newly positive coeliac serology, please refer promptly and ask them to stay on gluten until the biopsy can be taken.
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).
Positive HLA-DQ2/DQ8 genotyping is not diagnostic of coeliac disease. The test is most helpful for excluding coeliac disease when negative.
Note that after diagnosis and adoption of a gluten free diet almost all management of coeliac disease can be undertaken in the community by General Practitioner, patient and dietitian working together – supported by advice from the Coeliac Society of Australia and HealthPathways (log in required).
Category 3 referrals are accepted at the discretion of the triaging clinician. If you are concerned that your patient requires specialist review, but the referral is declined, you are encouraged to contact the triaging clinician 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.
- HealthPathways SA - Coeliac Disease in Adults (log in required)
- National Institute for Health and Care Excellence (NICE) - Recommendations Guideline Coeliac Disease: Recognition, Assessment and Management 2015
- Gastroenterological Society of Australia