Colitis, Crohn's disease or IBS
What the FAA's documents say about colitis, Crohn's disease or IBS, in plain words, with the FAA's own words one press away.
FAA term: Colitis (Ulcerative, Regional Enteritis or Crohn's disease) or Irritable Bowel Syndrome
Short version
The FAA's table sorts it into two rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row AColitis (ulcerative, regional enteritis or Crohn's disease) or irritable bowel syndrome, all classes. The table's evaluation data is to submit all pertinent medical information and a current status report, including the duration of symptoms, the name and dosage of drugs, and side effects. | Worksheet | CACI |
| Row BNot CACI qualified. The worksheet has the examiner note that in Block 60, defer, and submit supporting documents. | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Colitis, Crohn's disease or IBS
- Row A · CACI
Colitis (ulcerative, regional enteritis or Crohn's disease) or irritable bowel syndrome, all classes. The table's evaluation data is to submit all pertinent medical information and a current status report, including the duration of symptoms, the name and dosage of drugs, and side effects. The table sends the examiner to the CACI worksheet for colitis. If the airman meets all certification criteria, the examiner issues.
Colitis (Ulcerative, Regional Enteritis or Crohn's disease) or Irritable Bowel Syndrome … All … Submit all pertinent medical information and current status report, include duration of symptoms, name and dosage of drugs and side effects … See CACI – Colitis Worksheet . If airman meets all certification criteria – Issue .
- Row B · Special Issuance
Not CACI qualified. The worksheet has the examiner note that in Block 60, defer, and submit supporting documents. The table says an initial Special Issuance requires an FAA decision.
Initial Special Issuance – Requires FAA Decision
NOT CACI qualified. I have deferred. (Submit supporting documents.)
The FAA pathways for colitis, Crohn's disease or IBS
Which exam
Your step-by-step plan
Step 1: The progress note from the treating doctor or specialist
The note the examiner reviews, and what it shows.Within 90 days before the examA current, detailed progress note from a clinic visit with your treating physician or specialist, no more than 90 days before the exam. Your AME reviews it.
It shows
- The condition is stable, with no effects that would interfere with flight duties
- No surgery for the condition in the last 6 weeks
Show the FAA's words: The progress note from the treating doctor or specialist
the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam.
FAA source: CACI – Colitis Worksheet. FAA date 29 April 2026; checked by Crosscheck 14 October 2026.
A current, detailed Clinical Progress Note from the treating physician [ ] Condition is stable with no effects that would interfere with flight duties, AND
FAA source: CACI – Colitis Worksheet. FAA date 29 April 2026; checked by Crosscheck 14 October 2026.
A current, detailed Clinical Progress Note from the treating physician
AND [ ] No surgery for the condition in the last 6 (six) weeks.
FAA source: CACI – Colitis Worksheet. FAA date 29 April 2026; checked by Crosscheck 14 October 2026.
Step 2: The worksheet's criteria
Your medications for the condition, your symptoms, and the cause of the colitis.One or more of the medications the worksheet lists, with the limits it sets.
One or more of
- Linaclotide (Linzess) or plecanatide (Trulance)
- Tenapanor (Ibsrela)
- Oral steroids at prednisone 20 mg a day equivalent or less
- Oral budesonide 9 mg or less
- Steroid foams or enemas, or a budesonide enema
- Azathioprine (Imuran)
- Hyoscyamine, 1 to 2 times a week, no side effects, and no-fly 48 hours after use
- Loperamide, 16 mg a day or less, and no side effects
- Mercaptopurine (6-MP)
- Mesalamine (Asacol, Pentasa, Lialda)
- Methotrexate (Trexall)
- Sulfasalazine (Azulfidine)
Any single one of these, after a 2-week ground trial
- No post-dose observation time: tofacitinib (Xeljanz) or upadacitinib (Rinvoq)
- 4-hour post-dose observation time: adalimumab (Humira and all biosimilars), certolizumab (Cimzia), golimumab (Simponi), guselkumab (Tremfya), mirikizumab (Omvoh), risankizumab (Skyrizi), ustekinumab (Stelara) or vedolizumab (Entyvio)
- 24-hour post-dose observation time: infliximab (Inflectra, Remicade, Renflexis)
The worksheet's other criteria
- No symptoms, or mild diarrhea (less than 4 bowel movements a day) with or without mild abdominal pain or cramping
- No severe abdominal symptoms or fatigue which limits activity
- Crohn's disease, ulcerative colitis, microscopic colitis, or irritable bowel syndrome; any other cause requires an FAA decision
Show the FAA's words: The worksheet's criteria
Medications for condition
One or more of the following:
Guanylate Cyclase-C (GC-C) Agonist
linaclotide(Linzess), plecanatide (Trulance)
Sodium/Hydrogen Exchanger 3 Inhibitor
tenapanor (Ibsrela)
Steroids
Oral formulations prednisone 20 mg/day equivalent or less (see steroid conversion calculator)
Oral budesonide 9mg or less
Steroid foams or enemas/ budesonide enema
azathioprine (Imuran)
hyoscyamine - use 1-2 times a week with no side effects and no-fly 48 hours after use
loperamide less than or equal to 16 mg a day and no side effects
mercaptopurine (6-MP)
mesalamine (Asacol, Pentasa, Lialda)
methotrexate (Trexall)
sulfasalazine (Azulfidine)
FAA source: CACI – Colitis Worksheet. FAA date 29 April 2026; checked by Crosscheck 14 October 2026.
Any single medication listed below after a 2-week ground trial and:
No post-dose observation time:
JAK: tofacitinib (Xeljanz) and upadacitinib (Rinvoq)
4-hour post-dose observation time:
TNF: adalimumab (Humira and all biosimilars),certolizumab (Cimzia), golimumab (Simponi)
IL: guselkumab (Tremfya), mirikizumab (Omvoh), risankizumab (Skyrizi), ustekinumab (Stelara)
SAM: vedolizumab (Entyvio)
24-hour post-dose observation time:
TNF: infliximab (Inflectra, Remicade, Renflexis)
FAA source: CACI – Colitis Worksheet. FAA date 29 April 2026; checked by Crosscheck 14 October 2026.
Symptoms [ ] None or mild diarrhea (less than 4 bowel movements/day) with or without mild abdominal pain/cramping AND [ ] No severe abdominal symptoms or fatigue which limits activity.
FAA source: CACI – Colitis Worksheet. FAA date 29 April 2026; checked by Crosscheck 14 October 2026.
Cause of Colitis [ ] Crohn’s disease, ulcerative colitis, microscopic colitis, or irritable bowel syndrome Any other causes require an FAA decision.
FAA source: CACI – Colitis Worksheet. FAA date 29 April 2026; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
Row AWorksheetCACI
The table sends the examiner to the CACI worksheet for colitis. If the airman meets all certification criteria, the examiner issues.
Row BDefers to the FAASpecial Issuance
The table says an initial Special Issuance requires an FAA decision.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · CACI
Colitis (ulcerative, regional enteritis or Crohn's disease) or irritable bowel syndrome, all classes. The table's evaluation data is to submit all pertinent medical information and a current status report, including the duration of symptoms, the name and dosage of drugs, and side effects. The table sends the examiner to the CACI worksheet for colitis. If the airman meets all certification criteria, the examiner issues.
Colitis (Ulcerative, Regional Enteritis or Crohn's disease) or Irritable Bowel Syndrome … All … Submit all pertinent medical information and current status report, include duration of symptoms, name and dosage of drugs and side effects … See CACI – Colitis Worksheet . If airman meets all certification criteria – Issue .
- Row B · Special Issuance
Not CACI qualified. The worksheet has the examiner note that in Block 60, defer, and submit supporting documents. The table says an initial Special Issuance requires an FAA decision.
Initial Special Issuance – Requires FAA Decision
NOT CACI qualified. I have deferred. (Submit supporting documents.)
The CACI worksheet's criteria
Progress note
- The condition is stable, with no effects that would interfere with flight duties
- No surgery for the condition in the last 6 weeks
Your medications for the condition
One or more of
- Linaclotide (Linzess) or plecanatide (Trulance)
- Tenapanor (Ibsrela)
- Oral steroids at prednisone 20 mg a day equivalent or less
- Oral budesonide 9 mg or less
- Steroid foams or enemas, or a budesonide enema
- Azathioprine (Imuran)
- Hyoscyamine, 1 to 2 times a week, no side effects, and no-fly 48 hours after use
- Loperamide, 16 mg a day or less, and no side effects
- Mercaptopurine (6-MP)
- Mesalamine (Asacol, Pentasa, Lialda)
- Methotrexate (Trexall)
- Sulfasalazine (Azulfidine)
Any single one of these, after a 2-week ground trial
- No post-dose observation time: tofacitinib (Xeljanz) or upadacitinib (Rinvoq)
- 4-hour post-dose observation time: adalimumab (Humira and all biosimilars), certolizumab (Cimzia), golimumab (Simponi), guselkumab (Tremfya), mirikizumab (Omvoh), risankizumab (Skyrizi), ustekinumab (Stelara) or vedolizumab (Entyvio)
- 24-hour post-dose observation time: infliximab (Inflectra, Remicade, Renflexis)
The worksheet's other criteria
- No symptoms, or mild diarrhea (less than 4 bowel movements a day) with or without mild abdominal pain or cramping
- No severe abdominal symptoms or fatigue which limits activity
- Crohn's disease, ulcerative colitis, microscopic colitis, or irritable bowel syndrome; any other cause requires an FAA decision
Show the FAA's words: the CACI worksheet's criteria for Colitis, Crohn's disease or IBS
- Stable, with no effects that would interfere with flight duties
FAA criterion: the current, detailed clinical progress note from the treating physician shows the condition is stable with no effects that would interfere with flight duties.
A current, detailed Clinical Progress Note from the treating physician [ ] Condition is stable with no effects that would interfere with flight duties, AND
- No surgery for the condition in the last 6 weeks
FAA criterion, also under the progress note: no surgery for the condition in the last 6 (six) weeks.
A current, detailed Clinical Progress Note from the treating physician … AND [ ] No surgery for the condition in the last 6 (six) weeks.
- No symptoms, or only mild ones the worksheet describes
FAA criterion: symptoms none, or mild diarrhea (less than 4 bowel movements a day) with or without mild abdominal pain or cramping, and no severe abdominal symptoms or fatigue which limits activity.
Symptoms [ ] None or mild diarrhea (less than 4 bowel movements/day) with or without mild abdominal pain/cramping AND [ ] No severe abdominal symptoms or fatigue which limits activity.
- A cause of colitis the worksheet names
FAA criterion: the cause of colitis is Crohn's disease, ulcerative colitis, microscopic colitis, or irritable bowel syndrome. The worksheet says any other causes require an FAA decision.
Cause of Colitis [ ] Crohn’s disease, ulcerative colitis, microscopic colitis, or irritable bowel syndrome Any other causes require an FAA decision.
- Medications for the condition from the worksheet's list
FAA criterion: one or more of the following -- a guanylate cyclase-C (GC-C) agonist, linaclotide (Linzess) or plecanatide (Trulance); a sodium/hydrogen exchanger 3 inhibitor, tenapanor (Ibsrela); steroids, meaning oral formulations at prednisone 20 mg/day equivalent or less (the worksheet points to a steroid conversion calculator), oral budesonide 9 mg or less, or steroid foams or enemas or a budesonide enema; azathioprine (Imuran); hyoscyamine, used 1 to 2 times a week with no side effects and no-fly 48 hours after use; loperamide at 16 mg a day or less and no side effects; mercaptopurine (6-MP); mesalamine (Asacol, Pentasa, Lialda); methotrexate (Trexall); or sulfasalazine (Azulfidine).
Medications for condition … One or more of the following: … Guanylate Cyclase-C (GC-C) Agonist … linaclotide(Linzess), plecanatide (Trulance) … Sodium/Hydrogen Exchanger 3 Inhibitor … tenapanor (Ibsrela) … Steroids … Oral formulations prednisone 20 mg/day equivalent or less (see steroid conversion calculator) … Oral budesonide 9mg or less … Steroid foams or enemas/ budesonide enema … azathioprine (Imuran) … hyoscyamine - use 1-2 times a week with no side effects and no-fly 48 hours after use … loperamide less than or equal to 16 mg a day and no side effects … mercaptopurine (6-MP) … mesalamine (Asacol, Pentasa, Lialda) … methotrexate (Trexall) … sulfasalazine (Azulfidine)
- A single medication from the worksheet's second list, after a 2-week ground trial
The worksheet's list also allows any single medication listed under it after a 2-week ground trial, with a post-dose observation time by medication: none for the JAK medications tofacitinib (Xeljanz) and upadacitinib (Rinvoq); 4 hours for the TNF medications adalimumab (Humira and all biosimilars), certolizumab (Cimzia) and golimumab (Simponi), the IL medications guselkumab (Tremfya), mirikizumab (Omvoh), risankizumab (Skyrizi) and ustekinumab (Stelara), and the SAM medication vedolizumab (Entyvio); and 24 hours for the TNF medication infliximab (Inflectra, Remicade, Renflexis).
Any single medication listed below after a 2-week ground trial and: … No post-dose observation time: … JAK: tofacitinib (Xeljanz) and upadacitinib (Rinvoq) … 4-hour post-dose observation time: … TNF: adalimumab (Humira and all biosimilars),certolizumab (Cimzia), golimumab (Simponi) … IL: guselkumab (Tremfya), mirikizumab (Omvoh), risankizumab (Skyrizi), ustekinumab (Stelara) … SAM: vedolizumab (Entyvio) … 24-hour post-dose observation time: … TNF: infliximab (Inflectra, Remicade, Renflexis)
If the examiner defersSpecial Issuance
When the pilot is not CACI qualified, the worksheet has the examiner note in Block 60 that they have deferred, and submit supporting documents. The table says an initial Special Issuance requires an FAA decision.
The worksheet says any cause of colitis other than Crohn's disease, ulcerative colitis, microscopic colitis, or irritable bowel syndrome requires an FAA decision.
What the FAA lists to send
- Item 1. All pertinent medical information and a current status report, including the duration of symptoms, the name and dosage of drugs, and side effects.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
When the pilot is not CACI qualified, the worksheet has the examiner note in Block 60 that they have deferred, and submit supporting documents. The table says an initial Special Issuance requires an FAA decision.
AME MUST NOTE in Block 60 one of the following: … NOT CACI qualified. I have deferred. (Submit supporting documents.)
Initial Special Issuance – Requires FAA Decision
- Reason 2
The worksheet says any cause of colitis other than Crohn's disease, ulcerative colitis, microscopic colitis, or irritable bowel syndrome requires an FAA decision.
Cause of Colitis [ ] Crohn’s disease, ulcerative colitis, microscopic colitis, or irritable bowel syndrome Any other causes require an FAA decision.
What the FAA lists to send
- Item 1
All pertinent medical information and a current status report, including the duration of symptoms, the name and dosage of drugs, and side effects.
Submit all pertinent medical information and current status report, include duration of symptoms, name and dosage of drugs and side effects
After the FAA decides
AASIThe AASI sheet for colitis or irritable bowel syndrome says an FAA physician makes the first decision and grants the Authorization. After that, the sheet says the examiner may reissue under the Authorization when the pilot provides what it lists. The table says an initial Special Issuance requires an FAA decision, and for followup Special Issuances it points to the AASI Colitis Protocol.
Show the FAA's words: after the FAA decides
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR 67.401 . … Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
Initial Special Issuance – Requires FAA Decision … Followup Special Issuances – See AASI Colitis Protocol
What a Special Issuance is
The Guide says an Authorization for Special Issuance, valid for a specified period, may be granted at the Federal Air Surgeon's discretion to a person who does not meet the established medical standards, if the person shows to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of certificate applied for can be performed without endangering public safety during the period the Authorization would be in force.
How the FAA pathways workAt later examsAASI
- First and second class
- Every year
- Third class
- At each required exam
The worksheet says first- and second-class applicants must provide this information every year, and third-class applicants must provide it with each required exam.
Show the FAA's words: how often the FAA asks again
Applicants for first- or second-class must provide this information annually; applicants for third-class must provide the information with each required exam.
Under an FAA Authorization, the AASI sheet lists what the pilot provides for the examiner to reissue. That is the Authorization itself; a statement regarding the extent of disease; a statement regarding the frequency of exacerbation (flare-ups), beside which the sheet says the applicant should cease flying with any exacerbation, as warned in 61.53; and the name and dosage of the medications used for treatment and/or prevention, with comment regarding side effects.
Show the FAA's words: at later exams
Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following: … An Authorization granted by the FAA; … A statement regarding the extent of disease; … A statement regarding the frequency of exacerbation (the applicant should cease flying with any exacerbation as warned in 61.53 ); and … The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects.
What AASI is
AASI stands for AME Assisted Special Issuance. The Guide describes it as a process that lets the examiner reissue a certificate under the provisions of an Authorization for Special Issuance, to an applicant who has a medical condition that is disqualifying under 14 CFR part 67.
How the FAA pathways workThe Authorization granted by the FAA
The AASI sheet's list for a reissue begins with the Authorization the FAA granted.
Show the FAA's words: The Authorization granted by the FAA
Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following: … An Authorization granted by the FAA;
Statements on the extent of disease and the frequency of flare-ups
The AASI sheet asks for a statement regarding the extent of disease, and a statement regarding the frequency of exacerbation (flare-ups). Beside the second it says the applicant should cease flying with any exacerbation, as warned in 61.53.
Show the FAA's words: Statements on the extent of disease and the frequency of flare-ups
A statement regarding the extent of disease; … A statement regarding the frequency of exacerbation (the applicant should cease flying with any exacerbation as warned in 61.53 ); and
The name and dosage of medications, with comment on side effects
The AASI sheet asks for the name and dosage of the medications used for treatment and/or prevention, with comment regarding side effects.
Show the FAA's words: The name and dosage of medications, with comment on side effects
The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects.
What the Authorization letter comes with
The AASI sheet says the Authorization letter comes with attachments that specify the information the treating physicians must provide for the reissue determination.
Show the FAA's words: What the Authorization letter comes with
The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination.
When the examiner defers a reissue
The AASI sheet says the examiner must defer to the AMCD or Region if there is a current exacerbation of the illness; if the pilot is taking medications such as Lomotil, steroid doses equivalent to more than 20mg of prednisone per day (the sheet points to a steroid conversion calculator), antispasmodics, and anticholinergics; or if the pattern of exacerbations is increasing in frequency or severity, or the pilot underwent surgical intervention.
Show the FAA's words: When the examiner defers a reissue
The Examiner must defer to the AMCD or Region if: … There is a current exacerbation of the illness; … The applicant is taking medications such as Lomotil, steroid doses equivalent to more than 20mg of prednisone per day ( steroid conversion calculator ), antispasmodics, and anticholinergics; or … The pattern of exacerbations are increasing in frequency or severity; or applicant underwent surgical intervention.
Good to know
Points from the FAA's own documents that are easy to miss.
What a progress note must include
In most cases it should come from a visit with the treating physician no more than 90 days ago, and cover the history, medications with dosages and side effects, exam findings, test results, diagnosis, assessment and plan, prognosis and follow-up. The FAA's sheet says to make sure the physician adds the prognosis. A portal note or an After Visit Summary that does not meet these criteria is not enough, and neither is a simple "ok to fly" letter. The FAA's documents also call it a status report.
Show the FAA's words: good to know, 1
your patient portal to print out “notes” or an “After Visit Summary (AVS).” … Patient Portal notes or an AVS that do not meet the criteria listed below for a detailed Clinical Progress Note are NOT sufficient for FAA purposes. … To be “current,” in MOST CASES, the detailed Clinical Progress Note should be from an evaluation in which you saw your treating physician no more than 90 days ago. … It Must include the following items: … A summary of the history of the condition, … Current medications, dosages, and side effects (if any); … Clinical exam findings; … Results of any testing performed; … Diagnosis; … Assessment and Plan; … Prognosis (This item may not be on a standard progress note, make sure your physician adds this information.); and … Follow-up … Please note: A letter stating, “Mr. Smith is ok to fly” (or any other simple note), is NOT a current, detailed Clinical Progress Note and is NOT acceptable. … You may also see this called a “current status report” or “status report” in current FAA Guidance. Any reference to a “status report” equals the criteria listed on this sheet.
Hyoscyamine has a 48-hour no-fly time
For hyoscyamine the worksheet sets use of 1 to 2 times a week with no side effects, and no-fly for 48 hours after use.
Show the FAA's words: good to know, 2
hyoscyamine - use 1-2 times a week with no side effects and no-fly 48 hours after use
Observation times after a dose
Any single medication on the worksheet's second list is allowed after a 2-week ground trial. The worksheet sorts them by observation time after a dose: none for tofacitinib (Xeljanz) and upadacitinib (Rinvoq), then 4 hours, then 24 hours.
Show the FAA's words: good to know, 3
Any single medication listed below after a 2-week ground trial and: … No post-dose observation time: … JAK: tofacitinib (Xeljanz) and upadacitinib (Rinvoq) … 4-hour post-dose observation time: … 24-hour post-dose observation time:
The examiner notes one of three statements
The worksheet says the examiner must note one of three in Block 60: CACI qualified (no documents to the FAA); a current or previous SI/AASI but now CACI qualified; or not CACI qualified and deferred, with documents submitted.
Show the FAA's words: good to know, 4
AME MUST NOTE in Block 60 one of the following: … CACI qualified colitis. (Documents do not need to be submitted to the FAA.) … Has current OR previous SI/AASI but now CACI qualified colitis. … NOT CACI qualified. I have deferred. (Submit supporting documents.)
The first AASI is deferred to the FAA
For a first-time AASI application for this condition, with all the medical information needed for a determination, the AASI sheet says the examiner must defer and submit all of it to the AMCD or RFS for the initial determination.
Show the FAA's words: good to know, 5
If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
What the AASI says about flare-ups
Beside its line on how often flare-ups (exacerbations) happen, the AASI sheet says the applicant should cease flying with any exacerbation, as warned in 61.53.
Show the FAA's words: good to know, 6
A statement regarding the frequency of exacerbation (the applicant should cease flying with any exacerbation as warned in 61.53 ); and
FAA sources
Every FAA document this page relies on, with the FAA's own date and the date Crosscheck last read it. The documents to print open at the FAA, so they are always the FAA's current ones.
- Open to print: CACI – Colitis Worksheet, a PDF at the FAA, in a new tab
- ColitisOpen to print: Colitis, a page at the FAA, in a new tab
Special Issuance
- AASI – Colitis or Irritable Bowel SyndromeOpen to print: AASI – Colitis or Irritable Bowel Syndrome, a page at the FAA, in a new tab
The sheet the examiner follows to reissue under an FAA Authorization.
AASI
- Open at the FAA: Pilot Information – What a Detailed Clinical Progress Note must contain, a PDF at the FAA, in a new tab
Medication guidance
Medications Crosscheck lists as taken for colitis, Crohn's disease or IBS, each with its own page on what published FAA guidance says about it.
- Medication for colitis on the FAA's colitis worksheet
- Guanylate cyclase-C (GC-C) agonist, on the FAA's colitis worksheet
- Anti-diarrheal on the FAA's colitis worksheet
- Medication for colitis on the FAA's colitis worksheet
- Medication for colitis on the FAA's colitis worksheet
- Guanylate cyclase-C (GC-C) agonist, on the FAA's colitis worksheet
- Sodium/hydrogen exchanger 3 inhibitor, on the FAA's colitis worksheet
This reports what the FAA has published. It is not medical advice, and it does not say how the FAA or an examiner will decide a case.