Section 1 of 7
⚠ Please answer all questions before continuing.
Over the past week, have you felt pain or discomfort in your upper abdomen (the pit of your stomach)?
During the past week, have you experienced the following?
An unpleasant stinging or burning sensation in your chest?
Sour or bitter fluid flowing up from your stomach to your throat?
During the past week, have you experienced the following?
An empty or hungry sensation in your stomach between meals?
Feeling nauseous or like you might vomit?
Vibrations or noise in the stomach
During the past week, have you experienced the following?
Feeling bloated or like your stomach is full of gas?
Burping more than usual?
Needing to pass gas more often than usual?
During the past week, have you been bothered by the following?
Difficulty passing stools?
Stools been hard at times?
Bowels not being fully empty after going to the toilet?
During the past week, have you been bothered by the following?
Going to the toilet more often than usual?
Stools been loose or watery at times?
Urgent need to go to the toilet
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