2.
Excessive belching, burping
3.
Bloating or fullness commencing during or shortly after a meal
4.
Sensation of food sitting in stomach for a prolonged period after a meal
6.
Loss of appetite, or nausea
1 out of 6
8.
Stomach pain, burning or aching, 1 to 4 hours after eating
9.
Feeling hungry just an hour or two after eating
10.
Indigestion or heartburn from spicy or fatty food, citrus, alcohol or caffeine
11.
Stomach discomfort or pain in response to strong emotions, thoughts or smell of food
12.
Heartburn aggravated by lying down or bending forward
13.
Antacids, carbonated beverages, milk, cream or food relieve the above symptoms
15.
Difficulty or pain when swallowing
16.
Vomiting blood or vomitus has appearance of coffee-grounds
2 out of 6
18.
Indigestion, bloating and fullness for several hours after eating
19.
Abdominal cramps or aches
20.
Nausea and/or vomiting
21.
Excessive passage of gas
22.
Diarrhoea (loose, watery or frequent bowel movements)
23.
Constipation (requiring straining, or a hard, dry or small stool)
24.
Alternating constipation and diarrhoea
25.
Undigested food in stools
26.
Stools greasy, smelly or stick to toilet bowl
28.
Certain foods worsen abdominal symptoms
29.
Dry flaky skin and dry brittle hair
30.
Difficulty gaining weight
3 out of 6
31.
Lower abdominal pain, cramping and/or spasms
32.
Lower abdominal pain relieved by passing gas or stool
33.
Excessive gas and bloating
34.
Certain foods or stress aggravate lower abdominal pain
35.
Diarrhoea (loose, watery or frequent bowel movements)
36.
Constipation (requiring straining, or a hard, dry or small stool)
37.
Alternating diarrhoea and constipation
38.
Sensation of incomplete emptying of bowel
39.
Extremely narrow stools
40.
Mucus or pus in stool
41.
Red blood with bowel movement
42.
Rectal pain or cramps
4 out of 6
44.
Upper abdominal pain, or pain under ribs
45.
Bloating or feeling of fullness after eating
46.
Excessive gas and bloating
47.
Fatty foods cause indigestion or nausea
49.
Nausea and/or vomiting
50.
Unexplained itchy skin
51.
Yellowish discolouration of skin or eyes, or dark coloured urine
52.
Pale clay-coloured stools
53.
Fatigue, malaise or weakness
54.
Fluid retention, oedema
55.
Easy bruising or bleeding (e.g. of gums)
56.
Loss or thinning of body hair
57.
Red skin, particularly on palms
58.
Dry, flaky skin or dry hair
5 out of 6
59.
Have you had stomach banding?
60.
Have you had gastric bypass surgery?
61.
Have you had your gallbladder removed?
62.
Do you take Ozempic or similar drugs? If so please state.
63.
Have you had a history of cancer? If so please state details.
64.
Do you suffer with anxiety? If so, are you taking medication (please add in the comments)
65.
Do you suffer with depression? If so, are you taking medication (please add in the comments)
66.
Are you taking prescription medications? If yes, please list in the comments.
67.
Do you suffer with allergies?
68.
Do you have any skin conditions? If yes, please state.
6 out of 6
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