GERD Symptom Assessment Tool

This tool helps assess potential GERD (Gastroesophageal Reflux Disease) symptoms. Please answer all questions honestly based on your recent experiences.

How often do you experience heartburn?

Never (0 points)
Sometimes (1 point)
Often (2 points)
Always (3 points)

How often do you experience chest pain related to eating?

Never (0 points)
Sometimes (1 point)
Often (2 points)
Always (3 points)

How often do you have difficulty swallowing?

Never (0 points)
Sometimes (1 point)
Often (2 points)
Always (3 points)

How often do you experience regurgitation (food coming back up)?

Never (0 points)
Sometimes (1 point)
Often (2 points)
Always (3 points)

How often do you experience throat irritation or soreness?

Never (0 points)
Sometimes (1 point)
Often (2 points)
Always (3 points)

How often do reflux symptoms disturb your sleep?

Never (0 points)
Sometimes (1 point)
Often (2 points)
Always (3 points)

How often do certain foods trigger your symptoms?

Never (0 points)
Sometimes (1 point)
Often (2 points)
Always (3 points)

How often does stress worsen your symptoms?

Never (0 points)
Sometimes (1 point)
Often (2 points)
Always (3 points)

How often do you smoke or use tobacco products?

Never (0 points)
Sometimes (1 point)
Often (2 points)
Always (3 points)

How often do you experience an acid or bitter taste in your mouth?

Never (0 points)
Sometimes (1 point)
Often (2 points)
Always (3 points)

How often do you experience bloating after meals?

Never (0 points)
Sometimes (1 point)
Often (2 points)
Always (3 points)

How often do you experience coughing at night?

Never (0 points)
Sometimes (1 point)
Often (2 points)
Always (3 points)