{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T10:05:26Z","timestamp":1784282726088,"version":"3.55.0"},"reference-count":13,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Naval aviation physical standards are designed to minimize the risk of sudden or subtle medical incapacitation that could degrade flight performance, compromise safety, or jeopardize mission completion. Within the current U.S. Navy Aeromedical Reference and Waiver Guide (ARWG), Crohn\u2019s disease (CD) remains categorically designated as \u201cwaivers not recommended\u201d across all aviation classes, in contrast to ulcerative colitis, which may be considered for waiver in select designated personnel. This distinction reflects historical concerns regarding unpredictable disease activity and the risk of gastrointestinal complications requiring urgent intervention. However, advances in surgical techniques, pharmacologic therapies, nutritional strategies, and monitoring capabilities have substantially altered the natural history of CD for select patients in sustained remission. Contemporary evidence demonstrates that appropriately selected individuals may achieve durable disease control with stable medication regimens and objective evidence of mucosal healing, supporting a more individualized assessment of aeromedical risk. In an era of constrained recruitment and prolonged training pipelines, aeromedical policy must balance force preservation with uncompromised flight safety. Accordingly, revision of ARWG Section 7.2 to permit structured, case-by-case waiver consideration for designated aviators with CD who demonstrate sustained clinical remission, absence of aeromedically significant complications, and stability on steroid-free therapy is recommended. Temporary grounding would remain appropriate following diagnosis, medication changes, or disease flare, with return-to-flight determined through interval reassessment. Modernizing aeromedical policy to reflect contemporary risk stratification rather than categorical exclusion would align waiver decision-making with current gastroenterology practice and established aeromedical risk-management principles. Such an approach supports retention of qualified aviators while maintaining the operational safety standards essential to Naval Aviation readiness.<\/jats:p>","DOI":"10.1093\/milmed\/usag328","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T09:23:58Z","timestamp":1784280238000},"source":"Crossref","is-referenced-by-count":0,"title":["Modernizing Aeromedical Standards for Crohn\u2019s Disease: A Risk-Stratified, Evidence-Informed Proposal for Waiver Reform"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3928-2920","authenticated-orcid":false,"given":"Jake","family":"Cresta","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Walter Reed National Military Medical Center , Bethesda, MD 20889,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Kwan","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Naval Medical Center San Diego , San Diego, CA 92134,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Tamayo","sequence":"additional","affiliation":[{"name":"Naval Aerospace Medical Institute , Pensacola, FL 32508,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Fiore","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Naval Medical Center San Diego , San Diego, CA 92134,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"2026071705235329300_usag328-B1","volume-title":"U.S. Navy Aeromedical Reference and Waiver Guide: Aviation Physical Standards","author":"U.S. Navy Aeromedical Institute","year":"2024"},{"key":"2026071705235329300_usag328-B2","doi-asserted-by":"publisher","first-page":"1225","DOI":"10.14309\/ajg.0000000000003465","article-title":"American college of gastroenterology clinical guidelines committee. ACG clinical guideline: management of crohn\u2019s disease in adults","volume":"120","author":"Lichtenstein","year":"2025","journal-title":"Am J Gastroenterol"},{"key":"2026071705235329300_usag328-B3","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1093\/ecco-jcc\/jjz180","article-title":"ECCO guidelines on therapeutics in Crohn\u2019s disease: medical treatment","volume":"14","author":"Torres","year":"2020","journal-title":"J Crohns Colitis"},{"key":"2026071705235329300_usag328-B4","doi-asserted-by":"publisher","first-page":"100764","DOI":"10.1016\/j.gastha.2025.100764","article-title":"Comparative efficacy of all available pharmaceutical therapies for moderate to severe crohn\u2019s disease: a systematic review and network meta-analysis","volume":"5","author":"Versteegh","year":"2026","journal-title":"Gastro Hep Adv"},{"key":"2026071705235329300_usag328-B5","author":"Kochar","year":"2024"},{"key":"2026071705235329300_usag328-B6","doi-asserted-by":"publisher","first-page":"900","DOI":"10.1016\/S2468-1253(20)30117-5","article-title":"Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn\u2019s disease: retrospective long-term follow-up of the LIR! 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