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. 2015 Jan 9;19(3):234–237. doi: 10.1055/s-0034-1399794

Table 1. Reflux Symptom Index.

During the last month, how did the following problems affect you? 0 = No problem; 5 = Severe problem/very troublesome
Hoarseness or a problem with your voice 0 1 2 3 4 5
Clearing your throat 0 1 2 3 4 5
Excess throat mucus or postnasal drip 0 1 2 3 4 5
Difficulty swallowing food, liquids, or pills 0 1 2 3 4 5
Coughing after you ate or after lying down 0 1 2 3 4 5
Breathing difficulties or choking episodes 0 1 2 3 4 5
Troublesome or annoying cough 0 1 2 3 4 5
Sensations of something sticking in your throat or a lump in your throat 0 1 2 3 4 5
Heartburn, chest pain, indigestion, or stomach acid coming up 0 1 2 3 4 5

Source: Belafsky et al.19