| Question |
Frequency score (points) for symptom |
| 0
day |
1
day |
2-3 days |
4-7 days |
|
1. How often did you have a burning
feeling behind your breastbone
(heartburn)? |
0 |
1 |
2 |
3 |
|
2. How often did you have stomach
contents (liquid or food) moving
upwards to your throat or mouth
(regurgitation)? |
0 |
1 |
2 |
3 |
|
3. How often did you have pain in the
centre of the upper stomach? |
3 |
2 |
1 |
0 |
|
4. How often did you have nausea? |
3 |
2 |
1 |
0 |
|
5. How often did you have difficulty
getting a good night’s sleep because
of your heartburn and/or
regurgitation? |
0 |
1 |
2 |
3 |
|
6. How often did you take additional
medication for your heartburn and/or regurgitation, other than what the physician told you to take? |
0 |
1 |
2 |
3 |
