Canadian Society of Intestinal Research • Pamphlets


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	CSIR Programs & Services	Intestinal Gas
	Celiac Disease	Irritable Bowel Syndrome (Chinese)
	Crohn's Disease (English)	Irritable Bowel Syndrome (English)
	Crohn's Disease (French)	Irritable Bowel Syndrome (French)
	Diverticular Disease	Pancreatitis (English)
	Functional Dyspepsia (English)	Pancreatitis (French)
	Functional Dyspepsia (French)	Stress Management
	GERD (Chinese)	Support Group
	GERD (English)	Ulcer Disease
	GERD (French)	Ulcerative Colitis (English)
	Hemorrhoids	Ulcerative Colitis (French)
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	Inflammatory Bowel Disease (English)	Video Library
	Inflammatory Bowel Disease (French)

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Gastroesophageal Reflux Disease (GERD) Are you taking prescription medication for any of the following stomach problems/symptoms: Stomach pain or discomfort Heartburn Sour taste in mouth/acid regurgitation Excessive burping/belching Increased abdominal bloating Nausea Early satiety If you answer yes to any one of the symptoms listed above then take this test to see if your current medication is adequately controlling your stomach symptoms. The PASS Test PPI* Acid Symptom Suppression Test
Are you still experiencing stomach symptoms? Yes No In addition to your main medication, are you taking any of the following medications to control your symptoms: antacids (e.g. TUMS®, Rolaids®, Maalox®), H2 blockers (e.g. ranitidine, Zantac®, Pepcid AC®), motility drugs, (e.g. Motilium®) or others (e.g. Gaviscon®, Pepto-Bismol®)? Yes No Is your sleep affected by your stomach symptoms? Yes No Are your eating and drinking habits affected by your stomach symptoms? Yes No At any time, do your stomach symptoms interfere with your daily activities? Yes No

*PPI is short for proton pump inhibitor, a class of medication used to suppress the acid in your stomach. These include Losec®, Nexium®, Pantoloc®, Pariet™, and Prevacid®.