Digestive Guidance Material

Implementing Rules (IRs), Acceptable Means of Compliance (AMCs) and Guidance Material (GM) on digestive conditions

The following are the requirements for the medical certification of aircrew, including guidance material issued by the UK CAA Medical Department in relation to the digestive system.

Implementing Rules

Acceptable Means of Compliance

Guidance Material

MED.B.020 Digestive System


(a) Applicants shall not possess any functional or structural disease of the gastro-intestinal tract or its adnexa which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
Class 1 & 2
(a) Oesophageal varices
Applicants with oesophageal varices should be assessed as unfit.
Medication used in Gastrointestinal Conditions

(b) 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.

(c) Applicants shall be free from herniae that might give rise to incapacitating symptoms.

Medical Reports - General
(d) Applicants with disorders of the gastro-intestinal system including:
   (1) recurrent dyspeptic disorder requiring medication;

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

Implementing Rules

Acceptable Means of Compliance

Guidance Material

Class 1
(e) Peptic ulceration
Applicants with peptic ulceration should be assessed as unfit pending full recovery and demonstrated healing.


Class 2
(e) Peptic ulceration
Applicants with peptic ulceration should be assessed as unfit pending full recovery.


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.

   (2) pancreatitis;
Class 1
(b) Pancreatitis
Applicants with pancreatitis should be assessed as unfit pending assessment.  A fit assessment may be considered if the cause (eg, gallstone, other obstruction, medication) is removed.
Medical Reports - General
Class 2
(b) Pancreatitis
Applicants with pancreatitis should be assessed as unfit pending satisfactory recovery.

   (3) symptomatic gallstones;
Class 1
(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) An applicant with asymptomatic multiple gallstones may be assessed as fit with a multi-pilot limitation.
Class 2
(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.



Implementing Rules

Acceptable Means of Compliance

Guidance Material


   (4) an established diagnosis or history of chronic inflammatory bowel disease;
Class 1
(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 that systemic steroids are not required for its control. 


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

Class 2
(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).


Medical Reports - General


   (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; shall be assessed as unfit.  A fit assessment may be considered after successful treatment or full recovery after surgery and subject to satisfactory gastroenterological evaluation.
Class 1
(f) Abdominal surgery
   (1) Abdominal surgery is disqualifying for a minimum of three months.  An earlier 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.
   (2) Applicants who have undergone a surgical operation on the digestive tract or its adnexa, involving a total or partial excision or a diversion of any of these organs, should be assessed as unfit for a minimum period of three months or until such time as the effects of the operation are no longer likely to interfere with the safe exercise of the privileges of the applicable licence(s).

Med.B.020 (d) (5) Abdominal Surgery
UK CAA guidance on certification following surgical procedures (digestive tract) to follow.

Medical Reports - General

Class 2
(f) Abdominal surgery
   (1) Abdominal surgery is disqualifying.  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.
   (2) Applicants, who have undergone a surgical operation on the digestive tract or its adnexa, involving a total or partial excision or a diversion of any of these organs, should be assessed as unfit until such time as the effects of the operation are no longer likely to interfere with the safe exercise of the privileges of the applicable licence(s).


Medical Reports - General




Implementing Rules

Acceptable Means of Compliance

Guidance Material

(e) Aero-medical assessment:
   (1) applicants for a class 1 medical certificate with the diagnosis of the conditions specified in (2), (4) and (5) shall be referred to the licensing authority;
   (2) fitness of class 2 applicants with pancreatitis shall be assessed in consultation with the licensing authority.