"It is more important to know what sort of person has a disease than to know what sort of disease a person has." - Hippocrates

Diagnostic Tool

In most cases, acid reflux and GERD are merely a symptom of underlying digestive problems caused by one or more factors such as: bacterial or fungal infection, neurological impairment, obesity, stress, diet, allergic reactions, posture, enzyme insufficiency and hypochloridia. Pinpointing the precise cause(s) is a key component of recovery. Conventional acid suppression drugs like proton pump inhibitors and antacids simply mask symptoms, neglecting the underlying causes of reflux. The Reflux Defense System is a systematic approach that ascertains the body's areas of weakness and targets the causes directly with natural remedies, dietary supplements, exercises and diet.

The diagnostic tool may be able to pinpoint common causes of reflux based on your lifestyle, symptoms and physical condition. Please answer the questions below to complete your reflux and GERD diagnostic evaluation.

Question 1: How often do you experience heartburn discomfort?

Rarely - less than once per month

Occasionally - once or twice a month

Often - several times per month.

Frequently - several times per week

Very Frequently - almost every day

Constantly - multiple times throughout the day

Question 2: When do symptoms usually occur (check all that apply)?

At bedtime and/or during sleep

After I drink carbonated soft drinks

After consuming alcohol, tobacco or coffee

After eating certain foods, for example: dairy, citrus fruits, fried foods, shellfish, tomatoes, etc.

After eating too much at one time

During times of stress

Question 3: If you are using antacids or acid blocking prescription drugs, how effective are these treatments?

I do not use antacids or acid blocking drugs

I use them but they provide little or no relief.

They provide temporary relief but I have to keep taking the drugs for the effect to last. They are not curing my reflux.

They resolve my reflux symptoms, my condition is getting better everyday and soon I won't need the drugs anymore.

Question 4: How long have you been taking acid blockers or antacids?

I do not use antacids or acid blocking drugs

Less than 2 weeks

Between 2-8 weeks

More than 8 weeks

Question 5: Are your currently taking any of the following medications (check all that apply)?

Beta-blockers

Bronchodilators (e.g. albuterol, ephedrine)

Calcium channel blockers (e.g. cardizem)

Demerol

Diazepam

Inderal

Nitrates

Nitroglycerine

NSAIDS (e.g. ibuprofen, naproxine)

Valium

Question 6: How would you describe your current body weight in relation to your height?

Slender - below average build or body weight

Average build or body weight - I'm about right

Slightly above average - I need to lose about 5 to 10 pounds

Above average body weight - I need to lose about 10 to 20 pounds

Overweight - I need to lose at least 20 pounds

Question 7: Do you experience or have you been diagnosed with any of the following conditions (check all that apply)?

Bad breath that does not go away with brushing or mouthwash

Difficulty swallowing

Feeling very hungry 1 to 3 hours after eating

Gastritis

Gastrointestinal bleeding

Recurring abdominal pain

Recurring nausea

Ulcers

Unexplained weight loss

Frequent indigestion, stomach bloating and fullness

Upper mid-abdominal pain or dull gnawing, particularly at night, that temporarily diminishes after meals or taking antacids

Question 8: Do you experience or have you been diagnosed with any of the following conditions (check all that apply)?

Adult Acne or Rosacea

Asthma

Bloating, belching, and flatulence immediately after meals

Bone weakness or Osteoporosis

Chronic fungal or yeast infections

Frequent indigestion, diarrhea, or constipation

Hair loss in women

Iron deficiency or anemia

Multiple food allergies or food sensitivities

Rectal itching

Redness or dilated blood vessels in the cheeks and nose

Soreness, burning or dryness of the mouth

Undigested food in the stools

Weak, peeling or cracked fingernails

Question 9: Do you experience or have you been diagnosed with any of the following conditions (check all that apply)?

Allergies

Cold Hands & Feet

Depression

Fatigue

Frequent Headaches

Hemorrhoids

Low Blood Pressure

Neck and Shoulder Aches

PMS

Pancreatitis

Skin Eruptions

Sprue (Wheat Intolerance)

Question 10: Do you experience or have you been diagnosed with any of the following conditions (check all that apply)?

Aching Feet

Arthritis

Bladder Infection

Breast Lumps

Breast Tumors

Bypass Surgery

Cataracts

Cirrhosis

Cystitis

Eczema

Gallbladder Problems

Gallstones

Hay Fever

Hepatitis

Hives

Jaundice

Prostate Problems

Psoriasis

Urinary Problems

Question 11: Do you experience or have you been diagnosed with any of the following conditions (check all that apply)?

Alcoholism

Arteriosclerosis

Back Problems

Muscle weakness

Candidiasis

Constipation

Ear Infections

Heart Disease

Herniated Disc

High Blood Pressure

Insomnia

Kidney Disease

Lower Back Ache

Loss of Hearing

Sciatica

Question 12: Do you experience or have you been diagnosed with any of the following conditions (check all that apply)?

Aching Knees

Chronic Allergies

Chronic Fatigue

Colitis

Crohn's Disease

Diverticulosis

Frequent Sinus Infections

Immune Depressed Conditions

Irritable Bowel Syndrome (IBS)

Milk Intolerance

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