II. Scoring
- How many times per week do each of the following symptoms occur per week
- Answers
- Score 0: Occurs on 0 days
- Score 1: Occurs on 1 day
- Score 2: Occurs on 2-3 days
- Score 3: Occurs on 4-7 days
III. Questions (Score 0-3 for each based on above)
- Burning feeling behind the Breastbone (Heartburn)?
- Stomach contents moving up to the throat or mouth (regurgitation)?
- Pain in the middle of the upper Stomach area?
- Nausea?
- Trouble getting a good night's sleep because of Heartburn or regurgitation?
- Need for over-the-counter medicine for Heartburn or regurgitation?