Gastroenterology

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

    Chronic Abdominal pain

    • Bowel obstruction
    • Abdominal sepsis

    Altered bowel habits

    • Acute Severe Colitis*

    *Acute severe colitis as defined by the Truelove and Witts criteria – all patients with ≥ 6 bloody bowel motions per 24 hours plus at least one of the following:

    • temperature at presentation of > 37.8°C,
    • pulse rate at presentation of > 90 bpm,
    • haemoglobin at presentation of < 105 g/L, CRP >30mg/dl at presentation (or ESR > 30 mm/hr)

    Diarrhoea

    • Severe persistent diarrhoea with dehydration
    • Acute Severe Colitis*

    *Acute severe colitis as defined by the Truelove and Witts criteria – all patients with ≥ 6 bloody bowel motions per 24 hours plus at least one of the following:

    • temperature at presentation of > 37.8°C,
    • pulse rate at presentation of > 90 bpm,
    • haemoglobin at presentation of < 105 g/L, CRP >30mg/dl at presentation (or ESR > 30 mm/hr)

    Dysphagia/odynophagia

    • Oesophageal foreign body / food bolus obstruction
    • At risk of dehydration and acute malnutrition
    • Supraglottitis

    Inflammatory Bowel Disease

    • Acute Severe Colitis*

    *Acute severe colitis as defined by the Truelove and Witts criteria – all patients with ≥ 6 bloody bowel motions per 24 hours plus at least one of the following:

    • temperature at presentation of > 37.8°C,
    • pulse rate at presentation of > 90 bpm,
    • haemoglobin at presentation of < 105 g/L, CRP >30mg/dl at presentation (or ESR > 30 mm/hr)

    Anaemia / Iron deficiency CPC

    • Haemodynamic instability or significant bleeding attributed to a gastrointestinal (GI) source
    • Severe anaemia (Hb <70 g/L) with risk of cardiovascular compromise or syncope
    • Anaemia with overt GI bleeding (e.g. haematemesis, melena)
    • Severe cytopenias in an unwell patient (e.g. infection, symptomatic anaemia, or active bleeding):
      • Neutrophils <0.5 × 10⁹/L
      • Haemoglobin <70 g/L
      • Platelets <20 × 10⁹/L
    • Pancytopenia (Hb <100 g/L, Neutrophils <1.0 × 10⁹/L, Platelets <50 × 10⁹/L)
    • Haemolytic anaemia
    • Abnormal blood film (circulating blasts, leucoerythroblastic or dysplastic changes)
    • New unexplained back pain with features suggestive of myeloma
    • Hypercalcemia
    Rapid Access Clinic (RACs)
    • Features suggestive of malignancy or significant structural disease, including:
      • Progressive dysphagia or odynophagia with inability to tolerate oral intake
      • Persistent vomiting with dehydration, electrolyte disturbance, or concern for obstruction
      • Palpable abdominal mass or lymphadenopathy with systemic symptoms or rapid
      • Progression
      • Unexplained weight loss (>5% over 6 months) with acute functional decline or clinical deterioration

    Rectal Bleeding

    • Acute severe lower GI tract bleeding
    • Acute Severe Colitis* (if bloody diarrhoea present)

  • Please note this is not an exhaustive list of all conditions for outpatient services and does not exclude consideration for referral unless specifically stipulated in the CPC out of scope section.

  • The following are not routinely provided in a public Gastroenterology service.

    • Screening colonoscopy in asymptomatic patients outside of the NHMRC guidelines


    NB: If a patient who has been fully investigated 2 years prior to referral.  The referrer and the receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy / colonoscopy procedures

Last updated: 29 September 2026

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