How often in the past week did you have a burning feeling behind your breastbone (heartburn)?
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0 days
1 day
2-3 days
4-7 days
How often in the past week did you have stomach contents (liquid or food) moving upwards to your throat or mouth (regurgitation)?
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0 days
1 day
2-3 days
4-7 days
How often in the past week did you have pain in the center of the upper stomach?
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0 days
1 day
2-3 days
4-7 days
How often in the past week did you have nausea?
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0 days
1 day
2-3 days
4-7 days
How often did you have difficulty getting a good night’s sleep because of your heartburn and/or regurgitation?
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0 days
1 day
2-3 days
4-7 days
How often did you take additional medication for your heartburn and/or regurgitation, other than what the physician told you to take (such as Tums, Rolaids and Maalox)?
0 days
1 day
2-3 days
4-7 days
Email
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