This self-assessment tool is sponsored by EndoStim and is not a replacement for visiting your physician or your physician's advice.
For how many years have you been suffering from reflux disease (heartburn, regurgitation)?
For how many years have you been taking proton pump inhibitor (PPI) medications such as omeprazole or pantoprazole (i.e. Nexium, Prilosec, Prevacid)?
How often do you take your PPI medication?
On a scale of 1 to 5, how satisfied are you with your current condition?
How often did you have a burning feeling behind your breastbone (heartburn?)
How often did you have stomach contents (liquid or food) moving upwards to your throat or mouth (regurgitation)?
How often did you have a pain in the middle of the upper stomach?
How often did you have nausea?
How often did you have difficulty getting a good nights sleep because of your heartburn and/or regurgitation?
How often did you take additional medication for your heartburn and/or regurgitation in other than what your physician told you to take?
Other comments
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