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Ip S, Bonis P, Tatsioni A, et al. Comparative Effectiveness of Management Strategies For Gastroesophageal Reflux Disease [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2005 Dec. (Comparative Effectiveness Reviews, No. 1.)
This publication is provided for historical reference only and the information may be out of date.
Comparative Effectiveness of Management Strategies For Gastroesophageal Reflux Disease [Internet].
Show detailsGastroesophageal Reflux Disease-Health-Related Quality-of-Life Scale
Scoring Scale
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 activities
Questions about symptoms (circle one of each question)
| 1. How bad is your heartburn? | 0 | 1 | 2 | 3 | 5 |
| 2. Heartburn when lying down? | 0 | 1 | 2 | 3 | 5 |
| 3. Heartburn when standing up? | 0 | 1 | 2 | 3 | 5 |
| 4. Heartburn after meals? | 0 | 1 | 2 | 3 | 5 |
| 5. Does heartburn change your diet? | 0 | 1 | 2 | 3 | 5 |
| 6. Does heartburn wake you from sleep? | 0 | 1 | 2 | 3 | 5 |
| 7. Do you have difficulty swallowing? | 0 | 1 | 2 | 3 | 5 |
| 8. Do you have pain with swallowing? | 0 | 1 | 2 | 3 | 5 |
| 9. If you take medication, does this affect your daily life? | 0 | 1 | 2 | 3 | 5 |
| 10. How satisfied are you with your present condition? | Satisfied | Neutral | Dissatisfied |
Reprinted from JOURNAL OF GASTROINTESTINAL SURGERY, 2(2), Velanovich V, “Comparison of Generic(SF-36) vs. Disease Specific Quality-of-Life (GERD-HRQL) Scales for Gastroesophageal Reflux Disease”, 141–145, (c) 1998, with permission of Society for Surgery of the Alimentary Tract.
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