GERD-Q acid reflux self-test

1) Whether you often have burning sensation behind your breastbone or chest pain, please select the frequency of occurrence.
a. 0 days
b. 1 day
c. 2-3 days
d. 4-7 days

2) Does the liquid or food in the stomach often pour into the throat or mouth? Please select the frequency of occurrence.
a. 0 days
b. 1 day
c. 2-3 days
d. 4-7 days

3) Do you often feel pain in the upper part of the stomach? Please select the frequency of occurrence.
a. 0 days
b. 1 day
c. 2-3 days
d. 4-7 days

4) Do you often feel nauseous (the feeling of vomiting)? Please select the frequency of occurrence.
a. 0 days
b. 1 day
c. 2-3 days
d. 4-7 days

5) Do you often fail to sleep at night due to acid reflux, food or stomach acid flooding into the esophagus or throat? Please select the frequency of occurrence.
a. 0 days
b. 1 day
c. 2-3 days
d. 4-7 days

6) Do you often take medicines such as gastric acid inhibitors, gastric acid neutralizers or histamine blockers to relieve heartburn, chest pain or acid reflux? Please select the frequency of occurrence.
a. 0 days
b. 1 day
c. 2-3 days
d. 4-7 days

Please calculate your score:
The scoring method for answering questions 1, 2, 5, and 6 👇🏻:
a. 0 days 0 minutes
b. 1 minute per day
c. 2 minutes in 2-3 days
d. 4-7 days 3 minutes

The scoring method for answering questions 3 and 4👇🏻:
a. 0 days 3 minutes
b. 2 points per day
c. 2-3 days 1 minute
d. 4-7 days 0 minutes

(Total score less than 8): The chance of suffering from acid reflux is very low.

Please continue to maintain good eating habits.

(Total score of 8 to 10): Shows that you have a slight acid reflux.

It is recommended to improve bad eating habits, such as avoiding frozen foods and drinks, coffee, alcohol, high-fat foods, etc.

(Total score from 11 to 13): Shows that you have suffered from acid reflux.

It is recommended to treat as soon as possible to find out the most suitable treatment method.

Reminder: This is a preliminary assessment questionnaire, which does not fully reflect the acid reflux status!