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* 1. Sufferers of DBR cannot burp naturally. Do you feel pain/pressure in your throat/oesophagus/behind your breast bone when it feels like you need to burp and it won't come out?

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* 2. How can you relieve this pain/pressure?

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* 3. Do you think you parp more often than others?

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* 4. Do you suffer from anxiety/stress? Please give a little detail about duration, severity, type...

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* 5. Do you have a hiatus/hiatal hernia? An endoscopy/x-ray may have shown this.

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* 6. Do you hiccup a lot/more than others?

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* 7. Do you suffer from acid reflux/heartburn?

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* 8. Can you throw up?

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* 9. Do you feel the need to swallow often? Do you find yourself swallowing for no reason?

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* 10. Please list foods, drinks, activities, and your thoughts about what makes your DBR worse. Please also list what makes your symptoms better

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