Background
Coeliac disease (CeD) requires timely specialist assessment, accurate serological and histological interpretation, and coordinated dietetic follow-up, yet patients outside metropolitan centres may face prolonged waits, fragmented assessment, and variable endoscopic biopsy quality. A multidisciplinary CeD clinic integrating gastroenterology, specialist dietetic care and pathology was established in a major regional centre to improve access to coordinated assessment and longitudinal follow-up.
Methods
A retrospective audit evaluated the clinic during early and mature phases. Demographics, referral-to-clinic waiting times, and diagnostic outcomes were reviewed. Patients with persistent suspicion of CeD following initially non-diagnostic endoscopy and histology underwent longitudinal reassessment, including repeat serology, HLA testing, multidisciplinary review, and repeat endoscopy with systematic duodenal sampling where indicated.
Results
A total of 123 new patients were assessed over three years. The early and mature cohorts comprised 62 and 61 patients, respectively, with similar sex distribution and mean age: 38.1 versus 41.4 years. Median referral-to-clinic waiting time decreased from 555 to 36 days. Seven patients were diagnosed with delayed or previously missed CeD after initially non-diagnostic endoscopy and histology. Mean duodenal biopsy number increased from 2.5 to 5.7 following multidisciplinary review and systematic biopsy recommendations. Repeat assessment confirmed Marsh 3 CeD in all seven patients. Median diagnostic delay was 2 years, ranging from 1 month to 4 years. One prior diagnosis of CeD was excluded after normal HLA testing, serology, and histology.
Conclusions
A multidisciplinary CeD clinic in a major regional centre improved access to specialist care and diagnostic accuracy. The model reduced waiting times, supported longitudinal reassessment, standardised biopsy practice, confirmed delayed or missed CeD, and enabled exclusion of an unsupported prior diagnosis. Adequate gluten exposure, documented biopsy sampling, and repeat investigation remain important when suspicion persists. A regional multidisciplinary clinic model may help address unmet need for coordinated chronic gastrointestinal disease care outside metropolitan settings.