Esophageal varices
What the FAA's documents say about esophageal varices, in plain words, with the FAA's own words one press away.
Covers: All classes
Show the FAA's words: which classes the FAA's table covers
ESOPHAGEAL VARICES All Classes
- Rows A and B say that if the underlying cause is identified, for example cirrhosis, see that page. Cirrhosis has its own page.
Short version
The disposition table has three rows, and all three defer to the FAA for a possible Special Issuance.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row ASmall varices (grade 1 or F1) without red signs | Defers to the FAA | Special Issuance |
| Row BAny history of bleeding, after adequate treatment | Defers to the FAA | Special Issuance |
| Row CGrade 2-3, red signs, bleeding in 6 months, inadequately controlled | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Esophageal varices
- Row A · Special Issuance
Small varices (grade 1 or F1) without red signs. The row says that if the underlying cause is identified (for example, cirrhosis), see that page. The table lists five items to submit for FAA review. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings in Item 60.
A. Small varices (grade 1 or F1) without red signs If the underlying cause is identified (e.g., cirrhosis), see that page. Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings) in Item 60.
- Row B · Special Issuance
Any history of bleeding esophageal varies (as printed), after adequate treatment. The row says to see the corresponding page if the underlying cause is identified (for example, cirrhosis). After a 6-month recovery period, the table asks for all items in row A for FAA review; if less than 6 months recovery period, it says go to row C. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings in Block 60.
B. Any history of bleeding esophageal varies, after adequate treatment See corresponding page if underlying cause is identified (e.g., cirrhosis) After a 6-month recovery period, submit the following for FAA review: • All items in row A If less than 6 months recovery period, go to row C. DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings) in Block 60.
- Row C · Special Issuance
Enlarged or large varices (grade 2-3 or F2-3), or varies (as printed) of any size with red signs, or a history of bleeding esophageal varices within the past 6 months, or a disease process inadequately controlled. The table lists three items to submit for FAA review. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings in Block 60.
C. Enlarged or large varices (Grade 2-3 or F2-3) OR Varies of ANY size WITH red signs OR History of bleeding esophageal varices, within the past 6 months OR Disease process inadequately controlled Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings) in Block 60.
The FAA pathways for esophageal varices
Which one describes yours?
The FAA's table sorts it these ways. Choose yours to see its plan.
Your step-by-step plan
Step 1: The gastroenterologist's progress note and the EGD
Row A's first three items, which Row B asks for too.Progress note from a board-certified gastroenterologist
Within 90 days before the examA current, detailed progress note from a clinic visit with a board-certified gastroenterologist, no more than 90 days before the exam.
It must include
- A detailed summary of the history of the condition
- Current medications, dosage, and side effects, if any
- Physical exam findings
- Results of any testing performed
- Diagnosis, assessment and plan
- Prognosis and follow-up
It must specifically include
- The underlying cause of the varices
- Dates of any bleeding events, treatment, and outcome
- If there is no history of bleeding events, a statement saying so
- Size, grade, and location of the varices
- ANY red signs, for example red wale markings, or erythematous raised spots, also referred to as cherry red spots
- Prognosis for risk of bleeding
Most recent upper endoscopy (EGD) report
The report from the most recent upper endoscopy study/EGD (esophagogastroduodenoscopy).
Show the FAA's words: The gastroenterologist's progress note and the EGD
1. A current, detailed Clinical Progress Note generated from a clinic visit with a board-certified Gastroenterologist, no more than 90 days prior to the AME exam. It must include: • A detailed summary of the history of the condition; • Current medications, dosage, and side effects (if any); • Physical exam findings; • Results of any testing performed; • Diagnosis; assessment and plan; • Prognosis; and follow-up.
FAA source: Esophageal Varices. FAA date 25 February 2026; checked by Crosscheck 14 October 2026.
2. The Clinical Progress Note must specifically include: • Underlying cause of the varices; • Dates of any bleeding events, treatment, and outcome; • If no history of bleeding events, that should be stated; • Size, grade, and location of varices; • ANY red signs (e.g., red wale markings, erythematous raised spots, also referred to as cherry red spots); and • Prognosis for risk of bleeding.
FAA source: Esophageal Varices. FAA date 25 February 2026; checked by Crosscheck 14 October 2026.
3. Report from the most recent upper endoscopy study/EGD (esophagogastroduodenoscopy)
FAA source: Esophageal Varices. FAA date 25 February 2026; checked by Crosscheck 14 October 2026.
Step 2: Labs and other testing
Row A's last two items, which Row B asks for too.Labs, including a CBC
A complete blood count (CBC) performed within the past 90 days, and copies of other labs already performed or clinically indicated.
Other testing
Results of any other testing already performed or clinically indicated.
Show the FAA's words: Labs and other testing
4. Labs: • Complete Blood Count (CBC) performed within the past 90 days; and • Copies of other labs already performed or clinically indicated.
FAA source: Esophageal Varices. FAA date 25 February 2026; checked by Crosscheck 14 October 2026.
5. Results of any other testing already performed or clinically indicated.
FAA source: Esophageal Varices. FAA date 25 February 2026; checked by Crosscheck 14 October 2026.
Step 3: If the underlying cause is identified
For example cirrhosis, which has its own page.Rows A and B say that if the underlying cause is identified, for example cirrhosis, see that page.
Show the FAA's words: If the underlying cause is identified
A. Small varices (grade 1 or F1) without red signs If the underlying cause is identified (e.g., cirrhosis), see that page.
B. Any history of bleeding esophageal varies, after adequate treatment See corresponding page if underlying cause is identified (e.g., cirrhosis)
FAA source: Esophageal Varices. FAA date 25 February 2026; checked by Crosscheck 14 October 2026.
Step 4: See your AME
The table lists five items to submit for FAA review. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings in Item 60.Exam day- The table lists five items to submit for FAA review. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings in Item 60.
Show the FAA's words: See your AME
A. Small varices (grade 1 or F1) without red signs If the underlying cause is identified (e.g., cirrhosis), see that page. Submit the following for FAA review:
DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings) in Item 60.
FAA source: Esophageal Varices. FAA date 25 February 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 ADefers to the FAASpecial Issuance
The table lists five items to submit for FAA review. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings in Item 60.
If the examiner defersRow BDefers to the FAASpecial Issuance
After a 6-month recovery period, the table asks for all items in row A for FAA review; if less than 6 months recovery period, it says go to row C. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings in Block 60.
If the examiner defersRow CDefers to the FAASpecial Issuance
The table lists three items to submit for FAA review. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings in Block 60.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Special Issuance
Small varices (grade 1 or F1) without red signs. The row says that if the underlying cause is identified (for example, cirrhosis), see that page. The table lists five items to submit for FAA review. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings in Item 60.
A. Small varices (grade 1 or F1) without red signs If the underlying cause is identified (e.g., cirrhosis), see that page. Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings) in Item 60.
- Row B · Special Issuance
Any history of bleeding esophageal varies (as printed), after adequate treatment. The row says to see the corresponding page if the underlying cause is identified (for example, cirrhosis). After a 6-month recovery period, the table asks for all items in row A for FAA review; if less than 6 months recovery period, it says go to row C. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings in Block 60.
B. Any history of bleeding esophageal varies, after adequate treatment See corresponding page if underlying cause is identified (e.g., cirrhosis) After a 6-month recovery period, submit the following for FAA review: • All items in row A If less than 6 months recovery period, go to row C. DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings) in Block 60.
- Row C · Special Issuance
Enlarged or large varices (grade 2-3 or F2-3), or varies (as printed) of any size with red signs, or a history of bleeding esophageal varices within the past 6 months, or a disease process inadequately controlled. The table lists three items to submit for FAA review. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings in Block 60.
C. Enlarged or large varices (Grade 2-3 or F2-3) OR Varies of ANY size WITH red signs OR History of bleeding esophageal varices, within the past 6 months OR Disease process inadequately controlled Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings) in Block 60.
If the examiner defersSpecial Issuance
The table marks Row A, small varices (grade 1 or F1) without red signs, DEFER.
The table marks Row B, any history of bleeding esophageal varies (as printed) after adequate treatment, DEFER.
The table marks Row C, enlarged or large varices, varies (as printed) of any size with red signs, a history of bleeding within the past 6 months, or a disease process inadequately controlled, DEFER.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table marks Row A, small varices (grade 1 or F1) without red signs, DEFER.
A. Small varices (grade 1 or F1) without red signs … DEFER Submit the information to the FAA for a possible Special Issuance
- Reason 2
The table marks Row B, any history of bleeding esophageal varies (as printed) after adequate treatment, DEFER.
B. Any history of bleeding esophageal varies, after adequate treatment … DEFER Submit the information to the FAA for a possible Special Issuance
- Reason 3
The table marks Row C, enlarged or large varices, varies (as printed) of any size with red signs, a history of bleeding within the past 6 months, or a disease process inadequately controlled, DEFER.
C. Enlarged or large varices (Grade 2-3 or F2-3) OR Varies of ANY size WITH red signs OR History of bleeding esophageal varices, within the past 6 months OR Disease process inadequately controlled … DEFER Submit the information to the FAA for a possible Special Issuance
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 workGood 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.
An identified underlying cause has its own page
Rows A and B say that if the underlying cause is identified, for example cirrhosis, see that page.
Show the FAA's words: good to know, 2
If the underlying cause is identified (e.g., cirrhosis), see that page. … See corresponding page if underlying cause is identified (e.g., cirrhosis)
Row B's 6-month recovery period, and Row C's past 6 months
Row B asks for all items in row A after a 6-month recovery period, and says that with less than 6 months recovery period, go to row C. Row C includes a history of bleeding esophageal varices within the past 6 months.
Show the FAA's words: good to know, 3
After a 6-month recovery period, submit the following for FAA review: • All items in row A If less than 6 months recovery period, go to row C. … History of bleeding esophageal varices, within the past 6 months
Row C's list is not Row A's
Row A asks for a current, detailed progress note no more than 90 days prior to the exam, and lists five items, among them labs and other testing. Row C asks for the most recent detailed progress note and lists three items, the note, what it must specifically include, and the EGD report.
Show the FAA's words: good to know, 4
1. A current, detailed Clinical Progress Note generated from a clinic visit with a board-certified Gastroenterologist, no more than 90 days prior to the AME exam. … 4. Labs: • Complete Blood Count (CBC) performed within the past 90 days; and • Copies of other labs already performed or clinically indicated. … 5. Results of any other testing already performed or clinically indicated. … 1. The most recent detailed Clinical Progress Note generated from a clinic visit with a board-certified Gastroenterologist. … 3. Report from the most recent upper endoscopy study/EGD (esophagogastroduodenoscopy).
The table's word "varies"
Rows B and C print "varies" twice, in "bleeding esophageal varies" and "Varies of ANY size"; this page quotes both as printed.
Show the FAA's words: good to know, 5
B. Any history of bleeding esophageal varies, after adequate treatment … OR Varies of ANY size WITH red signs OR
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.
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.