Item | Frequency | |||||
---|---|---|---|---|---|---|
 | None | Less than one day a week | One day a week | 2-3 days a week | 4-6 days a week | Daily |
Burning behind the breastbone | 0 | 1 | 2 | 3 | 4 | 5 |
Pain behind the breastbone | 0 | 1 | 2 | 3 | 4 | 5 |
Acid taste in the mouth | 0 | 1 | 2 | 3 | 4 | 5 |
Unpleasant movement of material upwards from the stomach | 0 | 1 | 2 | 3 | 4 | 5 |
Epigastric burning | 0 | 1 | 2 | 3 | 4 | 5 |
Epigastric pain | 0 | 1 | 2 | 3 | 4 | 5 |
Item | Severity | |||||
 | None | Very mild | Mild | Moderate | Moderately severe | Severe |
Burning behind the breastbone | 0 | 1 | 2 | 3 | 4 | 5 |
Pain behind the breastbone | 0 | 1 | 2 | 3 | 4 | 5 |
Acid taste in the mouth | 0 | 1 | 2 | 3 | 4 | 5 |
Unpleasant movement of material upwards from the stomach | 0 | 1 | 2 | 3 | 4 | 5 |
Epigastric burning | 0 | 1 | 2 | 3 | 4 | 5 |
Epigastric pain | 0 | 1 | 2 | 3 | 4 | 5 |