Table 1.

GerdQ self-assessment questionnaire

	Symptoms in the	Symptom presence
	previous week
		0 days	1 day	2-3	4-7
				days	days
	Question:
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 a pain in the center 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 (such as Maalox)?	0	1	2	3