CACI Colitis FAA IBS IBD – Colitis is a broad, non-specific term that refers generally to any condition that causes inflammation of the large intestine, or colon. Quite literally, the word itself means colon inflammation. Symptoms of colitis can include abdominal pain, constipation, diarrhea, bloody stool, and fever.

Anyone who has suffered a round of food poisoning or other significant gastrointestinal infection can attest that just leaving the house can be challenging with some of those symptoms. Depending on which ones you experience and how bad they are, trying to fly an airplane with colitis could be downright reckless.

Deal with isolated colitis the way you would any acute illness

For those with transient, short-term colitis symptoms, the FAA is not generally concerned. If you sought medical care from a doctor for a stomach bug or other self-limited gastrointestinal problem, it is unlikely that it will affect your FAA medical certification. According to 14 CFR 61.53, you should not fly while your symptoms amount to a “medical deficiency” and you should disclose any related doctor’s appointment on your MedXPress application. But, after you recover, you can return to the cockpit without prior approval from your AME or the FAA.

Chronic colitis is more complicated

For those with recurrent colitis and those who used daily prescribed medication to control symptoms, the process is more complicated. Pilots with two chronic forms of colitis can still qualify for FAA medical certification as long as their symptoms are well controlled. The two most common causes of chronic colitis are Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD). IBD is further classified as either Crohn’s Disease or Ulcerative Colitis (UC).

If you have well-controlled IBS, Crohn’s Disease, or UC, your AME can still issue your certificate on the day of your exam provided you meet certain requirements. Be prepared to discuss your symptoms and treatment plan in detail with your AME. You should also schedule an appointment with the doctor who treats your condition within 90 days of your AME appointment and bring the note from that visit with you to your flight physical.

IBS and IBD are two of the 20 Conditions AMEs Can Issue (CACIs) that allow AMEs to issue medical certificates to pilots without prior FAA review. If you meet all the following criteria, your AME can issue your certificate without deferring your medical certificate application to the FAA for further review [1]:

• Your treating physician determines that your overall health and the status of your colitis is favorable
• You do not suffer from excessive fatigue
• If you have diarrhea, it is classified as mild or less
• If you have abdominal pain, is classified as mild or less
• Your diagnosis is IBS, Crohn’s Disease, or UC
• You have not had surgery for your colitis within six weeks of your AME exam
• You use one or more of the following medications:
  • Oral steroids which do not exceed a 20 mg/day prednisone equivalent [2]
  • Imuran or Sulfasalazine
  • Mesalamine
  • Topical steroids
  • Steroid enemas
  • 16 mg/day or less of loperamide (Diamode/Imodium)
  • Hyoscyamine no more than twice per week and not within 48 hours of flying
  • Mercaptopurine
  • Tofacitinib
  • Vedolizumab more than four hours before the flight

Unwritten rules

That might sound simple enough, but treatment for colitis in general and inflammatory bowel disease in particular evolve faster than FAA guidelines. Of special note, the FAA lists infliximab (Remicade) as specifically “NOT acceptable”, but in practice, they certify pilots treated with that medication somewhat routinely. 

Treatment guidelines have made other medications more common in the treatment of colitis [3]. While not incorporated formally into the FAA’s Guide for Aviation Medical Examiners, the Aeromedical Certification Division (AMCD) will consider qualifying pilots who use those medications on a case-by-case basis. Our FAA Medication Search tool provides information on the FAA’s policy on many commonly used medications.

Something else that is not explicit in the FAA CACI protocol is that just because you can use certain medications to control colitis symptoms does not mean that you must. Many IBS and IBD patients can adequately control their symptoms with diet and lifestyle modifications alone. If that applies to you, there is no need to start a medication just to meet the specifications detailed in the CACI instructions to AMEs.

Preparing for your flight physical

As with all medical conditions, preparing for your FAA medical certification exam starts by making an honest self-assessment and staying healthy. If your doctor has properly treated your condition and documented your care, the FAA will generally approve your medical certificate. Ignoring or concealing your symptoms can compromise your performance in the cockpit and make qualifying for your certificate much harder in the future.

If you still have questions about how colitis or other medical conditions could affect your FAA medical certification, visit our website to schedule a free consultation. In most cases, if your conditions are well-controlled, we can keep you flying.       

References

[1]      “C-CACIColitis.pdf.” Accessed: Dec. 18, 2022. [Online]. Available: https://www.faa.gov/sites/faa.gov/files/ame_guide/app_process/exam_tech/item38/C-CACIColitis.pdf

[2]      D. Liu et al., “A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy,” Allergy Asthma Clin. Immunol. Off. J. Can. Soc. Allergy Clin. Immunol., vol. 9, no. 1, p. 30, Aug. 2013, doi: 10.1186/1710-1492-9-30.

[3]      J. D. Feuerstein et al., “AGA Clinical Practice Guidelines on the Management of Moderate to Severe Ulcerative Colitis,” Gastroenterology, vol. 158, no. 5, pp. 1450–1461, Apr. 2020, doi: 10.1053/j.gastro.2020.01.006.

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