Is Severe Acid Reflux Affecting Your Life?

GERD Quiz

Gastroesophageal reflux disease (GERD) is a condition in which your stomach contents and gastric acid back up into your esophagus, causing a burning sensation in your throat and chest. Most cases of GERD can be treated effectively with medication and lifestyle changes. The goal of drug therapy is to reduce the level of acid in your stomach to relieve the symptoms of heartburn. Lifestyle changes like quitting smoking, weight loss and avoiding foods that cause symptoms may also offer relief of GERD symptoms. About 20-30% of patients will still have persistent symptoms despite medical management or may require escalating doses of acid medications. In these cases, surgery may be considered. If you have heartburn or GERD or take medication for those conditions, please complete the questionnaire to determine if surgery is a good treatment option for you.

0 = No Symptoms
1 = Symptoms noticeable, but not bothersome
2 = Symptoms noticeable and bothersome, but not every day
3 = Symptoms bothersome every day
4 = Symptoms affect daily activities
5 = Symptoms are incapacitating, unable to do daily activities

Questions:

1. How bad is your heartburn?(Required)
2. Do you have difficulty swallowing?(Required)
3. Do you have pain with swallowing?(Required)
4. Do you have bloating or gassy feelings?(Required)
5. Do your symptoms change your diet?(Required)
6. Do your symptoms wake you from sleep?(Required)
7. How satisfied are you with your current condition?(Required)
8. Do you experience regurgitation (contents refluxing when laying down or bending over)?(Required)
9. Are you currently taking any medications for heartburn?(Required)
12. Are you concerned with the warning regarding long-term heartburn medication use?(Required)
13. Are you interested in considering surgical treatment for GERD to either improve your symptoms or eliminate your heartburn medications?(Required)
14. Do you want to be contacted about treatment options?(Required)

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