- Pain in the upper abdomen
- Acid regurgitation
- Heartburn
- Increased burping and bloating
- Nausea or vomiting
- Feeling full too soon

Or have been diagnosed with any of the following conditions that may produce these types of symptoms;

- Helicobacter pylori infection
- Non-ulcer dyspepsia (functional dyspepsia)
- Peptic ulcer disease
- Gastroesophageal reflux disease (GERD)
- Hiatal hernia
- Gallstones

If you have been diagnosed with any of these conditions or you have experienced any of the symptoms listed above for at least three months, then this site's surveys are appropriate for you.

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About the survey

The purpose of the mydyspepsia questionnaire is to examine the association between symptom severity, quality of life and familiarity with dyspepsia, GERD and related conditions. One of the main goals of this survey is to compare those who come to see specialists to an "Internet population". Historically there have been significant differences between the two.

This survey should take about 10 minutes to complete and contains several sections:
1) Demographics;
2) the Dyspepsia & GERD Knowledge Questionnaire (DGKQ);
3) the SF-12 (a quality of life survey) and;
4) part of the Gastrointestinal Symptom Rating Scale (GSRS) to assess symptom severity.

Your responses will be reviewed by a clinical research associate at McMaster University's Division of Gastroenterology and an individualized report will be e-mailed to you. All eligible participants will automatically be entered into our draw to win $100 (CDN) by completing this survey- so make sure you provide an accurate e-mail address!

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Contest details

All eligible participants will be entered into a draw to win $100 (CDN) upon completion of the mydyspepsia survey. This promotional contest is open to age of majority residents of Canada only. One prize, totaling $100 CDN will be awarded to one entrant, chosen at random from all the entries and the winner will be notified by e-mail. The odds of winning will be determined by the number of entries. Contest closes August 1, 2002. You may complete this survey as often as you like, but you will only be entered in the draw once. Non-residents of Canada may also complete the questionnaire but are not eligible to participate in this contest. You will only be contacted by the site adjudicator to provide a summary and interpretation of your responses or if yours is the winning entry. The first name and province of residence of the winner will be published on the mydyspepsia.com site.

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Privacy policy

Be assured that your responses will be kept in the strictest confidence, and you will not be identifiable in any published reports. Your information will never be released to any third parties, but is being requested for research purposes only.

I have read the sections above and understand that my responses will be used for research purposes only, and that I may withdraw from the study by emailing the site adjudicator.