Refer young people and adults with positive serological test results to a gastrointestinal specialist for endoscopic intestinal biopsy to confirm or exclude coeliac disease NICE NG20.
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 NICE NG20.
Refer people with negative serological test results to a gastrointestinal specialist for further assessment if coeliac disease is still clinically suspected NICE NG20.
Refer if there are persistent symptoms, including diarrhoea, abdominal pain, weight loss, fatigue or unexplained anaemia, despite exclusion of gluten exposure NICE CKS.
Refer if there is suspected non-responsive or refractory coeliac disease NICE CKS.
Refer if there are concerns about ongoing gluten exposure, nutritional deficiencies, or growth impairment NICE CKS.
Refer urgently if there is suspicion of serious complications such as malignancy (e.g., lymphoma, small bowel adenocarcinoma, or pancreatic cancer) NICE CKS.