Answers for Pilots: Gastrointestinal Conditions

Are you eyeing the “everything” pizza—but you know you’ll fight with it for days? Or maybe you really are trying to eat healthier, but the increased salads and fruit have reaped a harvest of indigestion? You may have a gastrointestinal disorder such as gastroesophageal reflux disease (GERD).

There’s hope despite the heartburn. The FAA allows certification for many common gastrointestinal diagnoses as long as your treating physician documents the condition as stable and controlled. This includes gastric ulcer disease, gastroesophageal reflux disease (GERD), and the inflammatory bowel diseases that include colitis, regional enteritis, irritable bowel syndrome (IBS), and Crohn's disease.

Here is more specific information on the various conditions.

Gastric ulcer
If you have had an active ulcer, you 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 you are symptom-free.
2. Radiographic or endoscopic evidence that the ulcer is healed.
3. The type, dosage, and frequency of medication used. The use of any medications other than simple antacids and/or sucralfate medications, such as Carafate, for immediate and maintenance therapy of the ulcer may be disqualifying.
4. A history of bleeding ulcers usually requires interim status reports at six- to 12-month intervals following initial recertification.

Gastroesophageal reflux (GERD)
As you well know, if you have this condition, it 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 mimic angina, the chest pain associated with a possible heart attack.

The cause of the sphincter weakness isn't fully understood. However, certain medications, foods, and medical conditions add to the problem. The treatment for GERD includes life-style changes, weight reduction, medication, and, in severe cases, surgery.

The most commonly prescribed medications include Tagamet, Zantac, Pepcid, Axid, Prilosec, Aciphex, and Nexium. The FAA allows all these. At the time of your medical application renewal, you will need a current status letter from your treating physician summarizing the medication history, the dosage, frequency, and absence of side effects. If you have had surgery, complete hospital records along with a current status report will be necessary.

Chronic inflammatory bowel diseases
If you have regional enteritis (Crohn's disease), ulcerative colitis, or any diagnosis in this group of diseases, full medical documentation is required before a certification decision can be made. If surgery is required, especially for enteritis, 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 20 mg daily.

Ulcerative colitis is now a condition that the AME can issue (CACI).  Click here for the worksheet to provide to your treating physician to assist him or her in composing the status report.

Call the medical specialists at AOPA with questions, Monday through Friday, 8:30 a.m. to 6 p.m. Eastern at  800/USA-AOPA (872-2672).