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FAA releases GI-focused AME guide updates, to publish 'One Guide' publicly in phases
Summary
FAA medical staff announced multiple AME guide updates for gastrointestinal conditions — including new disposition tables and CACIs for MASLD/MASH (NAFLD/NASH), cirrhosis cognitive screening, variceal deferral guidance, liver-transplant timelines, and Alpha Gal Syndrome guidance — and said the internal One Guide system will be released to the public in phases beginning tomorrow.
The Federal Aviation Administration told aviation medical examiners during AME Grand Rounds that it has updated the AME guide with several gastrointestinal condition dispositions and will begin releasing its internal case-review system "One Guide" to the public in phases.
"This is Gastroenterology Month," Dr. Charles Mathers said, introducing a series of updates that include a condition index and multiple new disposition tables for MASLD (formerly NAFLD), MASH/NASH, cirrhosis, esophageal varices, liver transplant protocols, and Alpha Gal Syndrome. Mathers said the new material is intended to make it easier for AMEs to find conditions and to give clearer expectations for what documentation the FAA will need.
On MASLD/MASH/NASH, Mathers said most cases represent low aeromedical risk and that lower-risk cases may be handled under a CACI provided the pilot is asymptomatic and metabolic contributors (including insulin resistance) are adequately controlled. For MASH/NASH with concerning fibrosis, Mathers said the FAA will request a detailed clinical progress note from a treating physician or specialist and may defer higher-risk cases.
Mathers outlined acceptable noninvasive fibrosis assessments: a FIB-4 index, ultrasound-based vibration-controlled transient elastography, or magnetic resonance elastography. "The FIB-4 index just has to be less than 1.3," he said, and noted a typo in the published page listing a threshold of greater than 1.45 that will be corrected.
For cirrhosis, Mathers said the AME guide now distinguishes incidental radiologic findings (Row A) from confirmed cirrhosis requiring specialist documentation (Row B). The FAA will generally request a DCPN from a hepatologist or gastroenterologist, relevant labs and imaging, and a baseline cognitive (COG) screen at initial and follow-up exams to assess for minimal hepatic encephalopathy.
Esophageal varices guidance sets risk-based handling: small varices without red signs (Row A) may be acceptable with specialist documentation and recent endoscopy reports; prior bleeding requires at least a six-month recovery before reconsideration. Large varices, recent bleeding or red signs will generally result in deferral.
On liver transplantation, Mathers said donors more than 12 months post-donation typically require only routine AME exams, while transplant recipients generally require six months post-surgery plus three months of documented stability and DCPNs from the transplant team.
Mathers also described clarifications to the Colitis CACI — defining "mild diarrhea" as fewer than four bowel movements per day and adding microscopic colitis — and summarized Alpha Gal Syndrome guidance that treats most resolved or dietary-controlled cases as low risk but requires specialist documentation and Alpha Gal IgE testing for severe or ongoing reactions.
Mathers said the FAA intends to publish One Guide to the public in phases starting the next day, with Neurology available first, but he emphasized that the AME guide remains the primary source for AMEs.
The session closed without formal policy votes; presenters said updated disposition tables and CACIs are available in the AME guide and encouraged AMEs to follow the new documentation requirements when submitting cases for aeromedical decision.
