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cardiomyopathy, arrhythmia, and sudden death (see Chapter 1). Central nervous system involvement may
manifest as seizures or neurological deficit. Extensive pulmonary sarcoidosis may lead to cor pulmonale.
Sarcoidosis may also affect the skin, the liver, the spleen, the kidneys, etc.
There is no known cure for sarcoidosis. In general, the prognosis is good, especially if the disease is
limited to the lungs. However, the potential for involvement of the eyes, the heart, and the central nervous
system mandates a thorough examination and evaluation.
Active pulmonary disease entails unfitness for all classes of assessment. Applicants may be assessed as fit
for aviation duties once they are asymptomatic, off all medication (particularly steroids), and all test
ICAO Preliminary Unedited Version — October 2008 III-2-6
results are normal. The aeromedical decision should be made by the medical assessor and based on a
thorough investigation and evaluation in accordance with best medical practice. Close follow-up is
essential.
REFERENCES
Rayman, Russell B. et al.: Clinical Aviation Medicine, fourth edition. New York, 2006.
World Health Organization. Global Tuberculosis Control. WHO Report 2002. Geneva, Switzerland.
WHO/CDS/TB/2002.295.
World Health Organization: Tuberculosis and air travel: guidelines for prevention and control.
2nd ed. 2006
World Health Organization: Global Tuberculosis Control: Surveillance, Planning, Financing. March
2007
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ICAO Preliminary Unedited Version — October 2008
PART III
Chapter 3. DIGESTIVE SYSTEM
Page
Introduction............................................................................................................ III-3-1
Gastritis .............................................................................................................. III-3-1
Peptic ulcer ............................................................................................................. III-3-2
Uncomplicated peptic ulcer............................................................................... III-3-2
Complications:................................................................................................... III-3-2
— Recurrence.................................................................................................... III-3-2
— Bleeding ....................................................................................................... III-3-3
— Perforation .................................................................................................... III-3-3
Gastro-oesophageal reflux disease........................................................................ III-3-3
Biliary disorders..................................................................................................... III-3-3
Pancreatitis ............................................................................................................. III-3-4
Irritable colon......................................................................................................... III-3-4
Ulcerative colitis and Crohn’s disease.................................................................. III-3-4
Hernia ..............................................................................................................III-3-4
Other diseases......................................................................................................... III-3-4
References .............................................................................................................. III-3-5
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ICAO Preliminary Unedited Version — October 2008 III-3-1
INTRODUCTION
In the introductory chapters of this manual the basic principles for the assessment of an applicant’s
medical fitness for aviation duties are outlined.
The general provisions of Annex 1, 6.2.2 state that an applicant shall be required to be free from any
abnormality, disability, etc., “such as would entail a degree of functional incapacity which is likely to
interfere with the safe operation of an aircraft or with the safe performance of duties.”
The minimum standards for the digestive system of an applicant with regard to Class 1 Medical
Assessment are detailed in Annex 1, 6.3.2.13 to 6.3.2.14.1 (and in the corresponding paragraphs of
Chapter 6 for Class 2 and Class 3 Medical Assessments).
6.3.2.13 Applicants with significant impairment of function of the gastrointestinal tract or its adnexa shall be
assessed as unfit.
6.3.2.13.1 Applicants shall be completely free from those hernias that might give rise to incapacitating
symptoms.
6.3.2.14 Applicants with sequelae of disease of, or surgical intervention on, any part of the digestive tract or
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