Clinical Lead - Dr Jakob Begun
Catchment criteria applies for referrals for this service. Patient referrals from outside the Mater SEQ Catchment (which includes Metro South and West Moreton Hospital and Health Services) may not be accepted.
This page contains information on how to refer patients aged 16 years and over to Gastroenterology and Hepatology services at Mater Hospital Brisbane.
The Gastroenterology and Hepatology service at Mater Hospital Brisbane offer day procedure and outpatient clinics services. This service also offers a specialised young adult service for eligible patients aged between 16 and 25 years at Mater Young Adult Health Centre Brisbane.
The Gastroenterology and Hepatology Service is comprised of medical specialists, a Hepatology Nurse Practitioner, an IBD Clinical Nurse Consultant and specialised Clinical Nurses. Patients also have access to allied health services including physiotherapy, psychology, social work, occupational therapy and dietetics.
Specialised clinics are available for patients with
- Chronic liver disease, such as Hepatitis B and Hepatitis C Viruses
- Inflammatory Bowel Disease
Contact us
If you would like to discuss a referral, including clinical criteria, or update the status of a current patient please contact our priority GP phone line on 07 3163 2200
Bulk Billed Clinics
Mater Health Services offers patients the opportunity to attend bulk billed clinics. To provide your patient with the opportunity to attend a bulk billed specialist clinic, please provide a named referral to one of our specialists listed above.
Current Waiting Time for Appointments
We provide up to date data on how long patients are waiting for their first appointment by specialty here.
Referral Guideline Development
These Mater Referral Guidelines align with standardised best practice tools for referral to publicly funded specialist outpatient services developed in Queensland through the Clinical Prioritisation Criteria project.
Emergency care
If any of the following are present or suspected, phone 000 to arrange immediate transfer to the emergency department or seek emergency medical advice if in a remote region.
Emergency conditions
Potentially life threatening symptoms suggestive of
- Potentially life threatening symptoms suggestive of:
- Acute upper GI tract bleeding
- Acute severe lower GI tract bleeding
- Oesophageal foreign bodies/food bolus
- Acute Severe Colitis*
- Bowel obstruction
- Abdominal sepsis
- Severe vomiting and/or diarrhoea with dehydration
- Acute/fulminant liver failure (to be referred to a centre with dedicated hepatology services
- Biliary sepsis (to be referred to a centre with ERCP service)
Emergency Hepatology
- Potentially life-threatening symptoms suggestive of
- Acute severe GI bleeding
- Acute liver failure
- Sepsis in a patient with cirrhosis
- Severe encephalopathy in a patient with liver disease
- Acute/fulminant liver failure (to be referred to a centre with dedicated hepatology services
- Biliary sepsis (to be referred to a centre with ERCP service)
Emergency Endoscopy
Upper GI endoscopy
- Potentially life-threatening symptoms suggestive of:
- acute upper GI tract bleeding (bright red blood, PR bleeding, melena, hematemesis)
- acute severe lower GI tract bleeding
- Oesophageal foreign bodies/food bolus
- Displaced gastrostomy tube
Colonoscopy
- Potentially life-threatening symptoms suggestive of:
- Acute Severe Colitis*
- Bowel obstruction
- Abdominal sepsis
- Severe vomiting and/or diarrhoea with dehydration
*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 gm/l, CRP >20mg/dl at presentation (or ESR > 30 mm/hr)
Gastroenterology - Conditions in scope
Abdominal Pain
Essential information (Referral will be declined without this)
- General referral information
- Patient and family history of gastrointestinal cancer
- Previous endoscopic procedures (date, report and histology)
- ELFT FBC iron studies
- Relevant imaging reports
Other useful information for management (not an exhaustive list)
- Refer to Health Pathways or local guidelines
NB: If the patient who has been fully investigated 2 years prior to referral, then the referrer and the receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy/colonoscopy procedures.
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 - Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 - Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 - Routine Clinically recommended timeframe for initial appointment is 365 days |
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Altered Bowel Habit
Essential information (Referral will be declined without this)
- General referral information
- Patient and family history of gastrointestinal cancer
- FBC TSH iron studies results
- Coeliac serology results
Additional referral information (useful for processing the referral)
- Relevant imaging reports (e.g. pelvic USS)
- CA125
- Faecal calprotectin
- Faecal immunochemical test (FIT)
Other useful information for management (not an exhaustive list)
- Refer to Healthpathways or local guidelines
- Consider referring to a dietitian e.g. Fermentable oligo -, di-, mono-saccharides and polyols (FODMAP) diet
NB: If a patient who has been fully investigated 2 years prior to referral. Then the referrer and receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy/colonoscopy procedures.
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 - Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 - Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 - Routine Clinically recommended timeframe for initial appointment is 365 days |
Progressive or persistent symptoms that are significantly impacting activities of daily living despite medical management Progressive or persistent symptoms with concerning features
| Progressive or persistent symptoms despite medical management without concerning features | No category 3 criteria |
Barrett's Oesophagus Surveillance
Essential information (Referral will be declined without this)
- General referral information
- Previous endoscopic procedures (date, report and histology)
Other useful information for management (not an exhaustive list)
- Australian clinical practice guidelines for the diagnosis and management of Barrett's oesophagus and early oesophageal adenocarcinoma (2015) recommended screening endoscopy schedules:
- No dysplasia on endoscopic assessment and Seattle protocol biopsy
- Short (< 3 cm) segment – repeat endoscopy in 3–5 years
- Long (≥ 3 cm) segment – repeat endoscopy in 2–3 years
- If there has been previous low-grade dysplasia, see low-grade dysplasia protocol
- Seattle protocol—biopsy of any mucosal irregularity and quadrantic biopsies every 2 cm unless known or suspected dysplasia then quadrantic biopsies every 1 cm
- Indefinite for dysplasia on biopsy
- The changes of indefinite for dysplasia on biopsy should be confirmed by a second pathologist, ideally an expert gastrointestinal pathologist. If indefinite for dysplasia is confirmed, then the following endoscopic surveillance is recommended:
- Repeat endoscopy in 6 months with Seattle protocol biopsies for suspected dysplasia (biopsy of any mucosal irregularity and quadrantic biopsies every 1 cm) on maximal acid suppression
- If repeat shows no dysplasia, then follow as per non-dysplastic protocol
- If repeat shows low-grade or high-grade dysplasia or adenocarcinoma, then follow protocols for these respective conditions
- If repeat again shows confirmed indefinite for dysplasia, then repeat endoscopy in 6 months with Seattle protocol biopsies for suspected dysplasia.
- Low-grade dysplasia on biopsy
- The changes of low-grade dysplasia on biopsy should be confirmed by a second pathologist, ideally an expert gastrointestinal pathologist. If low-grade dysplasia is confirmed, then the following endoscopic surveillance is recommended (or refer to an expert centre for assessment):
- Repeat endoscopy every 6 months with Seattle protocol biopsies for dysplasia (biopsy of any mucosal irregularity and quadrantic biopsies every 1 cm.
- If 2 consecutive 6-monthly endoscopies with Seattle dysplasia biopsy protocol show no dysplasia, then consider reverting to a less frequent follow up schedule.
- The changes of low-grade dysplasia on biopsy should be confirmed by a second pathologist, ideally an expert gastrointestinal pathologist. If low-grade dysplasia is confirmed, then the following endoscopic surveillance is recommended (or refer to an expert centre for assessment):
- High-grade dysplasia or adenocarcinoma on biopsy
- Referral to a centre that has integrated expertise in endoscopy, imaging, surgery and histopathology
- NB: If a patient who has been fully investigated 2 years prior to referral. Then the referrer and receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy/colonoscopy procedures.
- Refer to Healthpathways or local guidelines
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 - Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 - Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 - Routine Clinically recommended timeframe for initial appointment is 365 days |
See other useful information for referring practitioners | See other useful information for referring practitioners) | See other useful information for referring practitioners |
Bowel Cancer Screening
Essential information (Referral will be declined without this)
- General referral information
- Patient and family history of bowel cancer
- U&E
- Previous endoscopic procedures (date, report and histology)
- For NBCSP patients with positive FOBT - include NBSCP pathology report / ID number
Other useful information for management (not an exhaustive list)
- Refer to Healthpathways or local guidelines
- Perform FOBT test every 2 years from age 50-74 years through NBCSP
NB: If a patient who has been fully investigated 2 years prior to referral. Then the referrer and the receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy / colonoscopy procedures
Clinical resources
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 - Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 - Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 - Routine Clinically recommended timeframe for initial appointment is 365 days |
iFOBT positive in patients > 50-74 years old | No category 2 criteria |
NB: these relatives with CRC can be taken from both sides of the family i.e. they do not have to be all on the same side.
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Coeliac Disease
Essential information (Referral will be declined without this)
- General referral information
- ELFT, FBC iron studies results
- Coeliac serology (TTG) results
NB If patients are on a gluten-free diet, advise them to add gluten to their diet for four weeks before diagnostic testing
Additional referral information (useful for processing the referral)
- TSH Vitamin B12 Folate 25-OH Vitamin D results
Other useful information for management (not an exhaustive list)
- Refere to Healthpathways or local guidelines
- Consider the following:
- Refer to a dietitian
- Monitor for diet compliance with coeliac disease serology every 6 to 12 months
- Screen family members with serology
- Baseline bone mineral densitometry
- Monitor for other auto-immune disorders
NB: If a patient has been fully investigated 2 years prior to referral, then the referrer and receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy/colonoscopy procedures.
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 - Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 - Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 - Routine Clinically recommended timeframe for initial appointment is 365 days |
Positive coeliac serology with concerning features Presence of concerning features
| Positive coeliac serology without red flags | No category 3 criteria |
Constipation
Essential information (Referral will be declined without this)
- General referral information
- Medical management to date (document treatments offered and efficacy including failed dietary/pharmocology intervention)
- FBC TSH iron studies results
- Serum calcium results
Additional referral information (useful for processing the referral)
- Relevant imaging reports (e.g. CT abdomen)
Other useful information for management (not an exhaustive list)
- Refer to Healthpathways or local guidelines
- Consider the following:
- Refer to a dietitian
- Bowel outlet obstruction
- Physiotherapist management of pelvic floor dysfunction
NB: If a patient has been fully investigated 2 years prior to referral. then the referrer and receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy/colonoscopy procedures.
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 - Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 - Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 - Routine Clinically recommended timeframe for initial appointment is 365 days |
New onset constipation in patients > 50 years old or patients with any of th efollowing concerning features
| Refractory symptoms not responding to medical management without concerning features and affecting activities of daily living | No category 3 criteria |
Diarrhoea
Essential information (Referral will be declined without this)
- General referral information
- Patient and family history of gastrointestinal cancer
- ELFT FBC TSH iron studies results
- Coeliac disease serology results
- Stool test results
- Previous gastrointestinal investigations and results (date and report)
Additional referral information (useful for processing the referral)
- CRP & Faecal calprotectin if inflammatory bowel disease is suspected
- Faecal immunochemical test (FIT)
- Relevant imaging reports
- Clostridium difficile toxin (if recent antibiotics)
- Recent travel history
Other useful information for management (not an exhaustive list)
- Refer to Healthpathways or local guidelines
- Consider referral to a dietitian, or for faecal incontinence
- NB: If a patient has been fully investigated 2 years prior to referral, then the referrer and receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy/colonoscopy procedures.
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 - Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 - Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 - Routine Clinically recommended timeframe for initial appointment is 365 days |
Diarrhoea > 6 weeks that is affecting activities of daily living and with any of the following concerning features:
| Diarrhoea > 6 weeks without concerning features | No category 3 criteria |
Dyspepsia/ Heartburn/ Reflux
Essential information (Referral will be declined without this)
- General referral information
- Family history of gastrointestinal cancers
- FBC, iron studies results
- Medical management to date (document treatments offered and efficacy including failed treatment with moderate dose PPI for dyspepsia)
Additional referral information (useful for processing the referral)
- Previous endoscopic procedures (date and report)
- Relevant imaging reports
- H pylori results
Other useful information for management (not an exhaustive list)
- Refer to the Healthpathways or local guidelines.
- Consider the following:
- Lifestyle modification (increased activity, dietary, weight, smoking, alcohol)
- Treatment if H pylori present
- Cease any aggravating medications if possible, e.g. NSAIDS, aspirin
- Antacid therapies
- Other evidence-based therapies (e.g. prokinetics)
NB: If a patient has been fully investigated 2 years prior to referral, then the referrer and receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy/colonoscopy procedures.
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 - Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 - Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 - Routine Clinically recommended timeframe for initial appointment is 365 days |
Any patient with significant impact on daily living, unexplained, persistent, or recent-onset symptoms (treatment-resistant) with any of the following concerning features:
| Any patient with significant, unexplained, persistent, or recent-onset symptoms (treatment-resistant) without concerning features | No category 3 criteria |
Dysphagia (Gastroenterology)
Essential information (Referral will be declined without this)
- General referral information
- History of presenting complaint:
- difficulty or pain on swallowing
- food or liquids are stuck in throat or chest
- pain or pressure in chest associated with swallowing
- loss of appetite/food avoidance associated with swallowing difficulty
- FBC iron studies results
Additional referral information (useful for processing the referral)
- Relevant imaging reports
Atopy
Other useful information for management (not an exhaustive list)
- Refer to Healthpathways or local guidelines
- NB: If a patient has been fully investigated 2 years prior to referral, then the referrer and receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy/colonoscopy procedures.
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 - Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 - Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 - Routine Clinically recommended timeframe for initial appointment is 365 days |
Significant dysphagia | No category 2 criteria | No category 3 criteria |
Inflammatory Bowel Disease
Essential information (Referral will be declined without this)
- General referral information
- ELFT FBC iron studies results
- CRP results
- Vitamin B12
- Stool M/C/S and PCR including Clostridium difficile (Category 1 referrals only)
- Relevant imaging reports
Additional referral information (useful for processing the referral)
- Faecal calprotectin
- 25-OH vitamin D results
Other useful information for management (not an exhaustive list)
- Refer to Health pathways or local guidelines
- Smoking cessation is likely to reduce disease activity in Crohn's disease
- NB: If a patient has been fully investigated 2 years prior to referral, then the referrer and receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy/colonoscopy procedures.
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 - Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 - Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 - Routine Clinically recommended timeframe for initial appointment is 365 days |
Previously diagnosed or suspected inflammatory bowel disease with any of the following concerning features:
| Stable previously diagnosed inflammatory bowel disease without concerning features | Monitoring and/or bowel cancer screening colonoscopy |
Iron Deficiency
Essential information (Referral will be declined without this)
- General referral information
- Family history of gastrointestinal cancer
- ELFT FBC iron studies results
- Coeliac disease serology results
- Menstrual history
Additional referral information (useful for processing the referral)
- Dietary history
- Urine dipstick results
Other useful information for management (not an exhaustive list)
- Refer to Healthpathways or local guidelines
- Consider referral to a dietitician
- NB: If a patient has been fully investigated 2 years prior to referral, then the referrer and receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy/colonoscopy procedures.
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 - Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 - Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 - Routine Clinically recommended timeframe for initial appointment is 365 days |
Iron deficiency anaemia or iron deficiency with any of the following concerning features
| Iron deficiency without any concerning features | No category 3 criteria |
Polyp Surveillance
Essential information (Referral will be declined without this)
- General referral information
- Relatives diagnosed with FAP
- Relatives diagnosed with HNPCC
- Family or personal history of colorectal cancer
- Previous endoscopic procedures (date, report and histology)
Other useful information for management (not an exhaustive list)
- Refer to Healthpathwyas or local guidelines
- NHMRC Clinical Practice Guidelines (2017) recommended screening colonoscopy schedules for polyp surveillance
- 5 yearly – If < 3 polyps (excluding diminutive rectosigmoid hyperplastic polyps) provided that all polyps are ‘simple’ as defined by dimensions (<10mm) and histopathology (no high-grade dysplasia or villous change)
- 3 yearly – If > 3 polyps (excluding diminutive rectosigmoid hyperplastic polyps) or if one or more polyps are ‘advanced’ as characterised by dimensions (≥10mm) and/or histopathology (presence of high-grade dysplasia or villous change)
- Annual – If 5 to 9 polyps (excluding diminutive rectosigmoid hyperplastic polyps)
- <12 months – If required, a baseline colonoscopy may need to be repeated in cases of poor bowel preparation (immediate rescheduling), possible incomplete excision of a large polyp (often at 3 months) or the presence of multiple adenomas (≥10) to ensure complete clearance
NB patients with Familial Adenomatous Polyposis (FAP) and Lynch syndrome (HNPCC) need punctual surveillance due to the high-risk nature of these conditions.
NB: If a patient has been fully investigated 2 years prior to referral, then the referrer and receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy/colonoscopy procedures.
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 - Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 - Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 - Routine Clinically recommended timeframe for initial appointment is 365 days |
See other useful information for referring practitioners | See other useful information for referring practitioners | See other useful information for referring practitioners) |
Rectal Bleeding
Essential information (Referral will be declined without this)
- General referral information
- Patient and family history of gastrointestinal cancer
- Documented duration, age of onset and associated symptoms
- FBC iron studies U&E results
- Previous gastrointestinal investigations and results (date and report)
- Rectal examination result
Other useful information for management (not an exhaustive list)
- Refer to Healthpathways or local guidelines
- If patient has haemorrhoids and no mass on DRE, refer if bleeding is recurrent or persists > 6 weeks
NB: If a patient has been fully investigated 2 years prior to referral, then the referrer and receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy/colonoscopy procedures
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 - Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 - Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 - Routine Clinically recommended timeframe for initial appointment is 365 days |
Rectal bleeding with any of the following concerning features:
| Rectal bleeding without concerning features | No category 3 criteria |
Hepatology - Conditions in scope
Abnormal Liver Function Tests / Jaundice
Autoimmune liver disease (Autoimmune Hepatitis, Primary Bilary Cirrhosis, Primary Sclerosing Cholangitis)
Elevated Iron Studies
Hepatic steatosis/ Non-alcoholic fatty liver disease (NAFLD)
Hepatitis B Virus
Hepatitis C Virus
Liver Cirrhosis
Space Occupying Liver Lesion
Essential information (Referral will be declined without this)
- General referral information
- Height, weight and BMI
- History of liver disease and/or previous cancer/s
- ELFTs FBC Alpha fetoprotein (AFP) results
- HBV HCV serology results
- Relevant imaging reports
Additional referral information (useful for processing the referral)
- Family history of HCC
- Past history of cancer e.g. colorectal cancer, gastric cancer
- History of liver disease
- Alcohol history
- Medication history including non-prescription medications, herbs, supplements
- INR results
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 - Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 - Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 - Routine Clinically recommended timeframe for initial appointment is 365 days |
Space occupying liver lesion on imaging | No category 2 criteria | No category 3 criteria |