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. 2008 Jul 14;14(26):4196–4203. doi: 10.3748/wjg.14.4196

Table 1.

Questionnaire used in this study

Please circle the appropriate responses for each of the following symptoms during a 1-mo period
Do you suffer from the symptom of dysphagia?
1: yes 2: no
(a: usually; b: sometimes)
(c: throat; d: chest; e: stomach)
Do you suffer from the symptom of heartburn?
1: yes 2: no
(a: usually; b: sometimes)
Do you suffer from the symptom of abdominal pain?
1: yes 2: no
(a: usually; b: sometimes)
(f: before eating; g: after eating; h: no relation)