Proposed Checklist for Evaluating the Impact of GERD
| Physical activities and function |
| Impaired in sport and exercise |
| Daily activities limited (housework, bending, lifting) |
| Avoidance of exertion |
| Emotional and social well-being |
| Avoidance of social situations triggering heartburn |
| Food/alcohol restrictions |
| Impaired sexual function |
| Feelings of pain and discomfort leading to low mood |
| Worry over general health status (anxiety) |
| Productivity—work and daily living activities |
| Symptoms leading to time off work |
| Symptoms impacting on productivity at work |
| Avoidance of activities that precipitate symptoms |
| Nocturnal symptoms affecting next-day performance |
| Sleep disturbances |
| Nocturnal heartburn present |
| Nighttime cough or asthma |
| Sleep disturbed by symptoms |
| Impact on next-day well-being and functioning |