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. 2016 Jan 30;22(1):60–68. doi: 10.5056/jnm15116

Table 1.

The Izumo Scale Questionnaire Respondents Enter the Severity Scores After Reflecting on Their Symptoms over the Previous Week

Question Not bothered Not so bothered Slightly bothered Bothered Strongly bothered Intolerably bothered
1. Are you bothered by acid reflux? 0 1 2 3 4 5
2. Are you bothered by heartburn centered in the anterior chest? 0 1 2 3 4 5
3. Are you bothered by throat discomfort? 0 1 2 3 4 5
4. Are you bothered by epigastric pain? 0 1 2 3 4 5
5. Are you bothered by hunger epigastric pain? 0 1 2 3 4 5
6. Are you bothered by epigastric burning sensation? 0 1 2 3 4 5
7. Are you bothered by early satiation? 0 1 2 3 4 5
8. Are you bothered by post-prandial long-lasting epigastric fullness or nausea? 0 1 2 3 4 5
9. Are you bothered by epigastric bloating? 0 1 2 3 4 5
10. Are you bothered by a feeling of incomplete defecation? 0 1 2 3 4 5
11. Are you bothered by constipation or hard stools? 0 1 2 3 4 5
12. Are you bothered by stress-related constipation? 0 1 2 3 4 5
13. Are you bothered by fecal urgency? 0 1 2 3 4 5
14. Are you bothered by diarrhea or soft stools? 0 1 2 3 4 5
15. Are you bothered by stress-related diarrhea? 0 1 2 3 4 5