The FAA allows certification for many common gastrointestinal diagnoses that can be documented as stable and well controlled. Included among this group of disorders are gastric ulcer disease, gastroesophageal reflux disease (GERD), esophagitis, hepatitis, and the inflammatory bowel diseases that include colitis, regional enteritis, irritable bowel syndrome (IBS), and Crohn's disease.
According to the peptic ulcer protocol contained in the FAA's Guide for Aviation Medical Examiners, persons who have had an active ulcer must show at least three months of stability without symptoms. If the ulcer involved bleeding, six months of stability is needed. Evidence of healing must be verified by a report from the treating physician that includes:
1. Confirmation that the applicant is symptom-free.
2. Radiographic or endoscopic evidence that the ulcer is healed.
3. Type, dosage, and frequency of medication used. The use of any medications other than simple antacids and/or sucralfate medication for immediate and maintenance therapy of the ulcer may be disqualifying. A history of bleeding ulcers usually requires interim status reports at six- to 12-month intervals following initial recertification.
Chronic inflammatory bowel diseases including regional enteritis (Crohn's disease), ulcerative colitis, or any diagnosis in this group of diseases, require full medical documentation before a certification decision can be made. If surgery is required, three to six months of stabilized recovery is recommended before applying for a medical certificate. Corticosteroids (prednisone), commonly prescribed for acute Crohn's disease, may be approved in dosages not exceeding 20mg. daily.
Gastroesophageal reflux, also known as GERD, is a condition that occurs when the lower esophageal sphincter located between the lower esophagus and the stomach fails to close after swallowing or opens at times when it shouldn't. When this happens, it allows stomach acid to pass into the esophagus causing a burning sensation ("heartburn") and other symptoms, including chest pains that often mimics angina, the chest pain associated with a possible heart attack.
The cause of the sphincter weakness isn't fully understood, but certain medications, foods, and medical conditions add to the problem. The treatment for GERD ranges from life-style changes, weight reduction, medication, and, in severe cases, surgery.
The FAA allows the use of the most commonly prescribed medications, such as Tagamet, Zantac, Pepcid, Axid, Prilosec, Aciphex, and Nexium. At the time of your medical application renewal, you will need a current status letter from your treating physician summarizing the medication usage history, the dosage, frequency, and absence of side effects. If surgery is necessary, complete hospital records along with a current status report will be necessary.
Colitis is now a CACI (Condition the AME Can Issue) and no longer requires a special issuance.
For other conditions such as ulcerative colitis or Crohn’s, after initial certification by FAA staff doctors, the AME will be authorized to reissue subsequent medical certificates under an AME- Assisted Special Issuance (AASI). The authorization letter issued by the FAA includes attachments that specify what information the treating physician(s) must provide for the renewal issuance. The examiner should defer renewal certification to the AMCD or Region if the airman's condition has adversely changed.
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