• 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 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.   Medication used in Gastrointestinal Conditions
    (b) Applicants who have herniae that might give rise to incapacitating symptoms shall be assessed as unfit.     

    (c) 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: 

    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.

     

    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.
     


    Medical Reports - General (PDF)

    Implementing Rules

    Acceptable Means of Compliance

    Guidance Material

    (1) recurrent dyspeptic disorder requiring medication 

    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.

    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 - 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.

    Medical Reports - General (PDF)
       (3) symptomatic gallstones;

    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. 

    Implementing Rules

    Acceptable Means of Compliance

    Guidance Material

       (4) a clinical diagnosis or documented medical history of chronic inflammatory bowel disease;
    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).

    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)

       (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.


    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.

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

    Medical Reports - General (PDF)

    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.

    Liver transplant guidance (PDF)

    Medical Reports - General (PDF)

    Implementing Rules

    Acceptable Means of Compliance

    Guidance Material

    (d) 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.

    .