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An applicant with a history of one episode of recurrence might be assessed as fit if symptom-free on a
normal (suitable) diet and provided there is evidence of clinical recovery. More than one episode of
recurrence calls for comprehensive medical investigation and evaluation. Should such an applicant
undergo surgery and the post-operative follow-up indicates complete recovery and virtual elimination of
the excess risk associated with complications, the condition may be regarded as an uncomplicated
(peptic) ulcer in remission which should require action as outlined above before return to flying duties.
Bleeding
ICAO Preliminary Unedited Version — October 2008 III-3-3
An applicant with a history of one single episode of bleeding as a complication may be assessed as fit if
without symptoms for a reasonable observation period (at least eight weeks), if no medication is required,
and if there is endoscopic evidence of healing. Assessment of fitness after recurrent bleeding episodes
should be made by the medical assessor and based on a thorough investigation. The medical assessment
should normally be limited to a period of validity of six months during the three years following a
bleeding episode. The need for follow-up should, however, be considered on an individual basis which
might require re-examination and evaluation at more frequent intervals than suggested above (every two
to three months). At each re-examination a statement from the attending surgeon on the current status of
the condition should be forwarded to the Licensing Authority for evaluation by the medical assessor.
Perforation
Perforation should be considered on an individual basis. The primary treatment, if technically possible, is
always a simple local procedure such as purse-string closure. This must be followed by eradication of
H.pylori. Only rarely is gastrectomy needed.
Cases treated surgically may be assessed as fit if the applicant shows endoscopic evidence of healing and
is free of subjective symptoms while performing flight duties.
GASTRO-OESOPHAGEAL REFLUX DISEASE
Gastro-oesophageal reflux disease (GERD) is a common disease in which the acid content of the stomach
is regurgitated up into the oesophagus. The primary symptoms of uncomplicated GERD are heartburn,
regurgitation, and nausea. The condition is chronic; once it begins, it is usually lifelong. The diagnosis is
made by oesophago-gastro-duodenoscopy, oesophageal pH probe, and manometry. Treatment includes
antacids, foam barriers, histamine H2 receptor antagonists, prokinetic agents, cytoprotective agents, and
proton pump inhibitors. Some patients may require surgery (fundoplication). Long-term maintenance
therapy may be necessary in many patients. In addition, the condition demands life style modifications,
especially dietary ones, which often are impractical for pilots.
Medical certification may be considered in cases where the frequency and intensity of episodes are low,
where complications such as oesophagitis, oesophageal ulcer, strictures, bleeding, and Barrett’s
oesophagus1 are absent, and where the medication prescribed has no significant side-effects.
BILIARY DISORDERS
Applicants with asymptomatic (large, solitary) gallstones need not require any special action and may be
assessed as fit.
Small multiple asymptomatic stones with functional gall-bladder may, however, cause colic and potential
incapacitation and are disqualifying until adequately treated.
1 Barrett’s oesophagus: peptic ulcer of the lower oesophagus, often with stricture and sometimes pre-malignant,
followed by oesophageal adenocarcinoma. After Norman R. Barrett, English surgeon (1903-1979)
ICAO Preliminary Unedited Version — October 2008 III-3-4
PANCREATITIS
This condition, unless very mild, is disqualifying for aviation duties.
Alcohol abuse as a causative factor should always be explored. Applicants with a history of pancreatitis
should be assessed individually and the aeromedical decision should be made in consultation with the
medical assessor and based on a thorough investigation and evaluation in accordance with best medical
practice. Close follow-up is essential.
IRRITABLE COLON
This is not an uncommon condition among aviation personnel. It may be aggravated by change of
environmental and working conditions e.g. operating routes, and might lead to incapacitating conditions
of varying severity.
The condition should generally be disqualifying if medication is necessary for control of symptoms. Often
the condition can be controlled by a diet rich in fibre, fruits and vegetables. If the symptoms are mild and
regular use of psychotropic or cholinergic medication is unnecessary, it may not be disqualifying.
ULCERATIVE COLITIS AND CROHN’S DISEASE
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Manual of Civil Aviation Medicine 1(118)
