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FAA CACI Eosinophilic Esophagitis Worksheet

Pilots with eosinophilic esophagitis that is well controlled on treatment can be certified at the AME's office under the FAA's CACI program. This worksheet, updated 04/29/2026, requires the most recent endoscopy with biopsy to show histologic remission and no fibrostenotic disease, no food impaction in the last 12 months or while on treatment, and treatment limited to listed options.

Who completes it

The AME completes the worksheet from a current, detailed Clinical Progress Note written after a clinic visit with the treating physician or specialist, such as a gastroenterologist, no more than 90 days before the AME exam.

Submitting and payment

How to submit it
If all criteria are met, the AME issues, notes 'CACI qualified Eosinophilic Esophagitis' in Block 60 and keeps the documents on file without sending them to the FAA; otherwise the AME defers and submits them.
Who pays
The FAA does not set AME examination fees; the pilot pays the examiner, and the FAA recommends the usual and customary local fee for similar services.

Good to know

  • Histologic remission means fewer than 15 eosinophils per high-power field; fibrostenotic disease includes esophageal rings, strictures or a narrow-caliber esophagus.
  • The endoscopy must fall within the treating gastroenterologist's recommended surveillance interval rather than a fixed number of months.
  • Accepted treatment is a proton pump inhibitor, topical or oral steroids not exceeding 20 mg prednisone a day, or dupilumab (Dupixent) with a 4-hour post-dose no-fly observation.
  • The treating physician must confirm the pilot is compliant with treatment, well controlled and free of medication side effects.

Get the official form

Download the current version from the source each time; forms change without notice.

CACI – Eosinophilic Esophagitis

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

What endoscopy results does the FAA EoE CACI need?

Documentation of the most recent endoscopy with biopsy, done within the gastroenterologist's recommended surveillance interval, showing fewer than 15 eosinophils per high-power field and no esophageal rings, strictures or narrow-caliber esophagus. The AME checks these findings against the worksheet.

Can a pilot taking Dupixent for eosinophilic esophagitis fly?

Under the CACI, dupilumab (Dupixent) is an accepted treatment, but it requires a 4-hour post-dose observation period during which the pilot does not fly. Proton pump inhibitors and topical or oral steroids up to 20 mg prednisone a day are also accepted.