What criteria should I use to determine whether to refer a patient with suspected coeliac disease for further testing?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Refer young people and adults with positive serological test results to a gastrointestinal specialist for endoscopic intestinal biopsy to confirm or exclude coeliac disease.

Refer children with positive serological test results to a paediatric gastroenterologist or paediatrician with a specialist interest in gastroenterology for further investigation for coeliac disease.

Refer people with negative serological test results to a gastrointestinal specialist for further assessment if coeliac disease is still clinically suspected.

Consider referral if serological titres are persistently high and show little or no change after 12 months, or if the patient has persistent symptoms including diarrhoea, abdominal pain, weight loss, fatigue, or unexplained anaemia.

Refer if there is suspected non-responsive or refractory coeliac disease, or if there is suspected serious complication such as malignancy.

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