Table 1—

Symptom questionnaire

SymptomsResponse
Upper abdominal discomfortNoneMildModerateSevere
RegurgitationNoneMildModerateSevere
BloatingNoneMildModerateSevere
HeartburnNoneMildModerateSevere
Loss of appetiteNoneMildModerateSevere
Nausea (# days per week _______)NoneMildModerateSevere
Vomiting (# times per week _______)NoneMildModerateSevere
Abdominal pain after eatingNoneMildModerateSevere
Abdominal pain between mealsNoneMildModerateSevere
Abdominal pain after drinking liquidsNoneMildModerateSevere
Early satiety (filling up very quickly)NoneMildModerateSevere
Burning sensation in chest/upper abdomenNoneMildModerateSevere
  • Symptom score = ___.