Digestive guidance material (GM)

1. Applicants with any sequelae of disease or surgical intervention in any part of the digestive tract or its adnexa likely to cause incapacitation in flight, in particular any obstruction due to stricture or compression, shall be assessed as unfit.
2. Applicants who have herniae that might give rise to incapacitating symptoms shall be assessed as unfit.
3. Applicants with any of the following disorders of the gastrointestinal system may be assessed as fit subject to satisfactory gastrointestinal evaluation after successful treatment or full recovery after surgery
   1. recurrent dyspeptic disorder requiring medication
   2. pancreatitis;
   3. symptomatic gallstones;
   4. a clinical diagnosis or documented medical history of chronic inflammatory bowel disease;
   5. after surgical operation on the digestive tract or its adnexa, including surgery involving total or partial excision or a diversion of any of these organs
4. Aero-medical assessment
   1. Applicants for a class 1 medical certificate with the diagnosis of any of the medical conditions specified in points (2), (4) and (5) of point (c) shall be referred to the medical assessor of the licensing authority.
   2. The fitness of applicants for a class 2 medical certificate with the diagnosis of the medical condition specified in point (2) of point (c) shall be assessed in consultation with the medical assessor of the licensing authority.

CLASS 1 - AMC1 MED.B.020
and
CLASS 2 - AMC2 MED.B.020

(a) Oesophageal varices
Applicants with oesophageal varices should be assessed as unfit.

CLASS 1 - AMC1 MED.B.020

(e) Peptic ulceration
Applicants with peptic ulceration should be assessed as unfit pending full recovery and demonstrated healing.

CLASS 2 - AMC2 MED.B.020

(e) Peptic ulceration
Applicants with peptic ulceration should be assessed as unfit pending full recovery.

CLASS 1 - AMC1 MED.B.020

(b) Pancreatitis
Applicants with pancreatitis should be assessed as unfit pending assessment. A fit assessment may be considered if the cause is removed.

CLASS 2 - AMC2 MED.B.020

(b) Pancreatitis
Applicants with pancreatitis should be assessed as unfit pending satisfactory recovery.

CLASS 1 - AMC1 MED.B.020

(c) Gallstones
(1) Applicants with a single asymptomatic large gallstone discovered incidentally may be assessed as fit if not likely to cause incapacitation in flight.
(2) Applicants with asymptomatic multiple gallstones may be assessed as fit with an OML.

CLASS 2 - AMC2 MED.B.020

(c) Gallstones
(1) Applicants with a single asymptomatic large gallstone or asymptomatic multiple gallstones may be assessed as fit.
(2) Applicants with symptomatic single or multiple gallstones should be assessed as unfit. A fit assessment may be considered following gallstone removal.

CLASS 1 - AMC1 MED.B.020

(d) Inflammatory bowel disease
Applicants with an established diagnosis or history of chronic inflammatory bowel disease should be assessed as fit if the inflammatory bowel disease is in established remission and stable and if systemic steroids are not required for its control.

CLASS 2 - AMC2 MED.B.020

(d) Inflammatory bowel disease
Applicants with an established diagnosis or history of chronic inflammatory bowel disease may be assessed as fit provided that the disease is stable and not likely to interfere with the safe exercise of the privileges of the applicable licence(s).

CLASS 1 - AMC1 MED.B.020

(f) Digestive tract and abdominal surgery

Applicants who have undergone a surgical operation for medical conditions of the digestive tract or its adnexa, including a total or partial excision or a diversion of any of these organs or herniae should be assessed as unfit. A fit assessment may be considered if recovery is complete, the applicant is asymptomatic, and there is only a minimal risk of secondary complication or recurrence.

CLASS 2 - AMC2 MED.B.020

(f) Digestive tract and abdominal surgery

Applicants who have undergone a surgical operation:

(1) for herniae; or

(2) on the digestive tract or its adnexa, including a total or partial excision or diversion of any of these organs

should be assessed as unfit. A fit assessment may be considered if recovery is complete, the applicant is asymptomatic, and there is only a minimal risk of secondary complication or recurrence.

CLASS 1 - AMC1 MED.B.020

(g) Liver disease
Applicants with morphological or functional liver disease, or after surgery, including liver transplantation, may be assessed as fit subject to satisfactory gastroenterological evaluation.

CLASS 2 - AMC2 MED.B.020

(g) Liver disease
Applicants with morphological or functional liver disease, or after surgery, including liver transplantation, may be assessed as fit subject to satisfactory gastroenterological evaluation.

Medication used in Gastrointestinal Conditions

Medical Reports - General (PDF)

Irritable Bowel Syndrome

Assessment by a consultant Gastroenterologist is required to exclude other medical conditions such as inflammatory bowel disease. Underlying stress should be addressed. If symptoms persist, increased physical activity and dietary modification may be helpful.

Symptom targeted medication may include antispasmodics, laxatives, antimotility medication and analgesics.

Certification for Class 1 or 2 is possible if symptoms are well controlled with acceptable medication. In intermittently symptomatic cases, an OML may be appropriate for Class 1 certificate holders.

Diverticular disease

Peppermint oil is acceptable for aeromedical certification when symptoms are controlled. If broad spectrum antibiotics are prescribed the licence holder should be considered unfit until the course is completed and symptoms have settled. If there is evidence of bleeding or during episodes of diverticulitis the licence holder is unfit. If colectomy is required for severe complications or failure to respond to medical treatment, the licence holder will be unfit until at least three months post operatively.

In intermittently symptomatic cases, an Operational Multipilot Limitation (OML) may be appropriate for Class 1 certificate holders.

Medical Reports - General (PDF)

Peptic ulceration

Aeromedical certificate holders will be assessed unfit while undergoing H. pylori eradication therapy. Following successful eradication of H. pylori proton pump inhibitors and H2 receptor antagonists are acceptable for maintenance therapy.

Medical Reports - General (PDF)

Inflammatory Bowel Disease

An aeromedical certificate holder with inflammatory bowel disease is assessed unfit unless the condition is in remission. For Class 1 the pilot must have been in remission on minimal medication for six months for aeromedical certification. Initially this will be with an Operational Multipilot Limitation (OML). This limitation can be reviewed after a further 6 months of remission. The applicant should be warned of the risk of significant interruptions in their ability to exercise licence privileges if their condition relapses.

Medication used in Gastrointestinal Conditions
Medical Reports - General (PDF)

Med.B.020 (d) (5) Abdominal Surgery

UK CAA guidance on certification following surgical procedures (digestive tract).

Liver transplant guidance (PDF)

Medical Reports - General (PDF)