IBD - Chrons disease - EASA / Local CAA guidelines

[mortennb]

Hi fellow colleagues,

In August 2020 I got diagnosed with crohn's diseases. Lightly affected, but the diagnosis was mine to have.
My medical was pulled, and I have since then been under treatment to meet the regulations / AMC. From what my searches can find, EASA / UK Guidelines states:

AMC1 MED.B.020 Digestive system ED Decision 2019/002/R .
(d) Inflammatory bowel disease Applicants with an established diagnosis or history of chronic inflammatory bowel disease should be assessed as fit if the inflammatory bowel disease is in established remission and stable and if systemic steroids are not required for its control.

AMC2 MED.B.020 Digestive system ED Decision 2019/002/R (d) Inflammatory bowel disease Applicants with an established diagnosis or history of chronic inflammatory bowel disease may be assessed as fit provided that the disease is stable and not likely to interfere with the safe exercise of the privileges of the applicable licence(s).

I have now been confirmed by my specialist to be in established clinical remission since May 2021. (12 months in remission for unrestricted Class 1)The local CAA authority has now asked for more details, as they cant find any definition on what type of remission is good enough.
In my understanding, there are 3 different definitions. Clinical remission, Endoscopic remission and histological remission.The local CAA has found that in UK guidelines, there is not any concrete definition, but they say that in Ernstring’s Aviation Medicine, it is mentioned that Endoscopic remission should (not shall) preferably be endoscopic. So they are putting weight on this.
My gastro specialist says that Chrons / Colitis is a chronic disease that always will have some sort of activity, but as long as the disease is stable, and the patient clinical issues are non existant, it not a big problem.

Has anyone any experience with such strickt interpetation?
Are there any EASA / UK Guidelines for definitons that might help me out?
I have been at home for close to 2 years now, 1 year as "healthy" fullfilling the quarantine required, with no steroids, but I take biological medication to keep the diseas in remission. A medication which is approved for maintenance.
But I am afraid that if the CAA requires endoscopic remission, with no signs of inflammation, that is quite different then havinng traces of inflammation but in established remission. Im so confused, and I feel almost as if the CAA is trying to find reasons for me not to fly, rather then use common sense.

Hoping for some insight and advice into people that have been through the same.
Thx in advance.

[421dog]

FAA, not CAA AME here….

Crohn’s is a total gi tract disease, that is likely with you forever, but doesn’t necessarily mean the end of your life as a pilot.
Most of the world has a more liberal approach to BRMs than does the FAA (they just last month approved Humera for RA as a CACI which is, as far as I know, the only exception to their blanket deferral associated with monoclonal therapies)
Anyway, I’ve got bunches of Crohns and other IBD airmen flying around happily without that stuff, but it really seems to work well, so if you’re on it, it’s working, and you’re not symptomatic, I’d bet you’ll be good to go. The likelihood of having a ‘“normal” upper and lower endoscopy with an actual crohns diagnosis is fairly low, but if it works, don’t knock it….

[mortennb]

FAA, not CAA AME here….

Crohn’s is a total gi tract disease, that is likely with you forever, but doesn’t necessarily mean the end of your life as a pilot.
Most of the world has a more liberal approach to BRMs than does the FAA (they just last month approved Humera for RA as a CACI which is, as far as I know, the only exception to their blanket deferral associated with monoclonal therapies)
Anyway, I’ve got bunches of Crohns and other IBD airmen flying around happily without that stuff, but it really seems to work well, so if you’re on it, it’s working, and you’re not symptomatic, I’d bet you’ll be good to go. The likelihood of having a ‘“normal” upper and lower endoscopy with an actual crohns diagnosis is fairly low, but if it works, don’t knock it….

Appreciate your reply.
Yes, my specialist also told me that when you have Chrons, its more normal to see certain affected areas in the GI tract. But he said that doesnt mean your not in remission. He stated its more an overall picture. Taking many results into concideration.
When I was diagnosed fall 2020, I had inflammation in both the small intestin & colon. When I redid an endoscopy in july 2021. The Colon was all fine, and they found no certain signs of affected small intestine. But biopsy confirm a small area still had activity.
My current AME is booking me for a new endoscopy now, where he says that if the results are the same as in july 2021. He can argue that the Chrons is showing stability and my condition is in remission. So I am hoping for the best.
Its just frustrating to go at home, feeling all good and fine. Not be able to fly. On top of the CAA not being able to take clinical remission as a good enough remission.

[421dog]

Well, I like your odds.
please feel free to pm me if I can be of any help…