1. I have had multiple episodes of abdominal pain or discomfort in the past year.

 
 

2. My bowel movements are irregular (constipation and/or diarrhea).

 
 

3. I feel better after having a bowel movement.

 
 

4. My stool is occasionally either very hard or soft and runny.

 
 

5. Sometimes my stool has mucus in it.

 
 

6. My digestive symptoms interfere with my daily life.

 
 

7. I experience digestive distress after eating certain foods.

 
 

8. My bowel movements sometimes cause me pain.

 
 

9. I have had blood in my stool in the past 3 months.

 
 

10. In the past year, I have experienced unintentional weight loss.

 
 

11. I belch or pass gas more frequently than I think is normal.

 
 

12. I experience heartburn at least twice a week.

 
 

13. I sometimes have difficulty swallowing, or feel a lump in my throat.

 
 

14. I frequently have a sore throat, especially in the morning.

 
 

15. Heartburn symptoms often wake me up at night.

 
 

16. I take over-the-counter antacids or acid reducers (Tums, Rolaids) more than twice a week for heartburn symptoms.

 
 

17. I have a family history of IBS, IBD, GERD.

 
 

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