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. However, pilots with certain chronic forms of colitis can still qualify for FAA medical certification as long as their symptoms are well controlled. 

Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD) were two of the earliest Conditions AMEs Can Issue (CACIs) that allow AMEs to issue medical certificates to pilots without prior FAA review. They remain on the list, but – just as the number of CACI conditions has grown in recent years – some existing CACI have broadened their scope. 

As of February 25, 2026, pilots with well controlled Crohn’s Disease, Ulcerative Colitis, microscopic colitis, and/or Irritable Bowel Syndrome can all leverage the FAA’s CACI program to receive their medical certificates immediately following their AME exam. The list of allowable medication has expanded as well.  

CACI Eligibility Requirements

Your AME may issue your certificate at the time of exam (without FAA deferral) if [1]:

• Your diagnosis is Crohn’s disease, ulcerative colitis, microscopic colitis, or IBS
• Your treating physician documents stable disease and favorable overall health
• You have not had colitis-related surgery within six weeks of the AME exam
• Diarrhea does not exceed four bowel movements per day
• Abdominal pain or cramping is mild or less
• You do not experience excessive fatigue 

You should see your treating physician within 90 days of your AME appointment and bring a current status note to your exam.

Acceptable Medications

The FAA now allows a broader list of medications under the CACI pathway, including:

GI motility agents

• Linaclotide (Linzess)
• Plecanatide (Trulance)
• Tenapanor (Ibsrela)

Steroids

• Oral steroids ≤ 20 mg/day prednisone equivalent [2]
• Oral budesonide ≤ 9 mg/day
• Steroid foams or budesonide enemas

Immunomodulators

• Azathioprine (Imuran)
• Mercaptopurine (6-MP)
• Methotrexate (Trexall)
• Sulfasalazine (Azulfidine)

Anti-inflammatory agents

• Mesalamine (Asacol, Pentasa, Lialda)

JAK inhibitors

• Tofacitinib (Xeljanz)
• Upadacitinib (Rinvoq)

Biologics

• Adalimumab (Humira and biosimilars)
• Certolizumab (Cimzia)
• Golimumab (Simponi)
• Mirikizumab (Omvoh)
• Ustekinumab (Stelara)
• Vedolizumab (Entyvio)
• Infliximab (Remicade, Inflectra, Renflexis)

Additional allowances:

• Loperamide ≤ 16 mg/day
• Hyoscyamine no more than twice weekly and not within 48 hours of flying

Unwritten rules

Treatment for IBD evolves faster than FAA policy updates. In the past, for example, infliximab was listed as “not acceptable,” yet the FAA routinely certified pilots using it when their condition was stable.

Even when not explicitly listed in the AME Guide, the Aeromedical Certification Division often considers guideline-supported medications without significant side effects [3]. Our FAA Medication Search tool provides information on the FAA’s policy on many commonly used medications.

It is also important to note that just because you can use certain medication to control colitis symptoms does mean that you must. Many pilots successfully control IBS or mild IBD through diet and lifestyle modification alone. You do not need to start medication solely to satisfy CACI criteria.

Preparing for your flight physical

As with all medical conditions, preparing for your FAA medical certification exam starts 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: Mar. 1, 2026. [Online]. Available: https://www.faa.gov/ame_guide/media/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.