Referral guidance for GPs
Suspected coeliac disease
When a non-biopsy diagnosis is appropriate, and when to refer for confirmatory biopsy — with your patient still on gluten.
Refer to the Coeliac Rapid Review ClinicKeep your patient on gluten until the diagnosis is confirmed
Do not start a gluten-free or low-gluten diet before serology and specialist review — it invalidates testing. A gluten-free diet is lifelong once diagnosed, so it is essential to secure the diagnosis first.
Initial workup
Request the following while your patient is eating gluten normally.
- Anti-tissue transglutaminase IgA (tTG-IgA) together with total serum IgA.
- Always report the laboratory reference range / upper limit of normal (ULN) alongside the numerical result.
- Consider FBE and iron studies. If total IgA is low or undetectable, request IgG-based coeliac serology.
Which pathway does your patient fall into?
Coeliac serology sorts most children down one of two routes.
Non-biopsy diagnosis may be possible
ESPGHAN 2020 pathway
ALL required- tTG-IgA at or above 10× the ULN
- Positive endomysial antibody (EMA-IgA) on a second, separate sample
- Normal total IgA
- Family understands and agrees (lifelong gluten-free diet)
HLA typing and symptoms are not required. These children can often be diagnosed without endoscopy. Refer with the results for confirmation and management.
Biopsy needed
Refer to the Coeliac Rapid Review Clinic
ANY of these- tTG-IgA positive but below 10× the ULN
- IgA deficiency (low or undetectable total IgA)
- Discrepant serology (e.g. tTG positive, EMA negative)
- Already on, or recently started, a gluten-free diet
- Diagnostic uncertainty or atypical presentation
Keep your patient on gluten and refer promptly. We arrange gastroscopy with duodenal biopsies to confirm the diagnosis before any dietary change.
Refer to the Rapid Review ClinicWhy the ULN matters
The 10× ULN threshold depends on the specific assay your laboratory uses, so a result reported simply as “positive” is not enough to determine the pathway. Please always include the numerical tTG-IgA value and your laboratory’s reference range.
What to include in your referral
- tTG-IgA value with the laboratory reference range / ULN
- Total IgA (and EMA if performed)
- Whether your patient is currently eating gluten — and, if not, when it stopped
- Symptoms, growth, family history, and any associated conditions such as type 1 diabetes
How to refer
Send your referral to Paediatric Gastroenterology Victoria and mark it for the Coeliac Rapid Review Clinic.
Please include the serology results (with your laboratory’s reference range) and confirm your patient remains on a gluten-containing diet. Our team will contact the family to arrange a prompt appointment.