For each question CIRCLE the number that best applies to your experience with that symptom over the past 3 months.

0 - Never or rarely – It is rare to experience this symptom.

1 - Occasionally – Once in awhile you may experience this – maybe once or twice a month.

2 - Often – You experience this 1-2 times a week, enough that it bothers you.

3 - Regularly – You are constantly aware of this as it occurs almost every day or weekly.

54. Loss of taste for meat

55. Burning stomach sensations, eating relieves

56. Coated tongue

57. Stomach “bloating” after eating

58. Indigestion, food “comes up” long after eating

59. Stomach spasms and/or cramping during or after eating

60. Food “sits” in your stomach long after a meal

61. Burping/Belching up to 2 hours after eating

62. Appetite reduced

63. Bad taste in your mouth

64. Bad breath

65. Bowel movements painful or difficult

66. Stomach is full even after small amounts of food

67. Lower bowel gas several hour after eating

68. Pass large amounts of foul-smelling gas

69. Stringy mucus in stool

70. Irritable Bowel

71. 2 or more large bowel movements daily

72. Frequent loose, watery stool

73. Bowel movement soon after eating (within 1 hour)

74. Consistency or form of stool changes (narrow, loose, formed…)

75. Undigested food in your stool

76. Heartburn

77. Allergies, Environmental

Total Score for Group 4