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* 1. Have you experienced burning pain or discomfort that moves up from your stomach to the middle of your chest or abdomen (heartburn)?

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* 2. How about burning pain into your throat after lifting an object?

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* 3. Have you had a sensation of acid backing up into your mouth after having a meal?

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* 4. How about a sour or bitter taste after burping?

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* 5. Do you have a feeling or inclination that you might vomit (nausea) after eating?

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* 6. Do you always feel bloated (stomach fullness) after having a meal?

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* 7. Do you experience pain or discomfort in the upper part of your stomach?

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* 8. How about stomach pain or fullness when bending or lifting an object?

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* 9. Do you experience heartburn when you lie down, especially on your back?

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* 10. Do you experience upper abdominal pain during night time?

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