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Health Corner

Functional Gastrointestinal Disorder Questionnaire

1In the last 3 months, how often did you have a feeling of a lump or something stuck in your throat?

2In the last 3 months, how often did you have pain or discomfort in the middle of your chest?

3In the last 3 months, how often did you have heartburn (a burning discomfort or burning pain in your chest)?

4In the last 3 months, how often did you feel so full after a regular-sized meal (the amount you normally eat)?

5Has it been 6 months or longer since you started having these episodes of fullness after meals?

6In the last 3 months, how often were you unable to finish a regular-size meal because you felt too full?

7Has it been 6 months or longer since you started having these episodes of feeling too full to finish regular-size meals?

8In the last 3 months, how often did you have pain or burning in the middle part of your upper abdomen (above your belly button)?

9Has it been 6 months or longer since you started having this pain or burning in the middle part of your upper abdomen?

10Did this pain or burning occur and then completely disappear during the same day?

11Usually, how severe was the pain or burning in the middle of your abdomen, above your belly button?

12Did this pain or burning usually get better or stop after a bowel movement or passing gas?

13In the last 3 months, how often did you have pain anywhere in your abdomen?

14Has it been 6 months or longer since you started having this pain anywhere in your abdomen?

Please choose the situation that fits you most for each of the following question.

<30%30%50%80%>80%
15How often did this pain in your abdomen happen close in time to a bowel movement—just before, during, or soon after? (Percent of times with pain)

<30%30%50%80%>80%

16How often did your stools become more frequent than usual when you had this pain? (Percent of times with pain)

<30%30%50%80%>80%

17How often did your stools become less frequent than usual when you had this pain? (Percent of times with pain)

<30%30%50%80%>80%

18How often did your stools become softer than usual when you had this pain? (Percent of times with pain)

<30%30%50%80%>80%

19How often did your stools become harder than usual when you had this pain? (Percent of times with pain)

<30%30%50%80%>80%

Please answer questions 20 and 21 according to the following stool forms:

<25%25%50%75%>75%
20In the last 3 months, how often did you have hard or lumpy stools (like Type 1 or 2) in the picture above? (Percent of all bowel movement)

<25%25%50%75%>75%

21In the last 3 months, how often did you have mushy or watery stools (like Type 6 or 7) in the picture above? (Percent of all bowel movement)

<25%25%50%75%>75%

For the above questions and results, references were made to American College of Gastroenterology’s Rome IV criteria *。

* Olafur S. Palsson, William E. Whitehead, Miranda A.L. van Tilburg, Lin Chang, William Chey, Michael D. Crowell, Laurie Keefer, Anthony J. Lembo, Henry P. Parkman, Satish S.C. Rao, Ami Sperber, Brennan Spiegel, Jan Tack, Stephen Vanner, Lynn S. Walker, Peter Whorwell, Yunsheng Yang, Development and Validation of the Rome IV Diagnostic Questionnaire for Adults, Gastroenterology, Volume 150, Issue 6, 2016, Pages 1481-1491.

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