Table 1.

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