Endo Education

RSI



The Reflux Symptom Index (RSI)

Within the last month, how did the following problems affect you?

Check the appropriate response.

0 = No Problem, 5 = Severe Problem

1. Hoarseness or a problem with your voice
0 1 2 3 4 5
2. Clearing your throat
0 1 2 3 4 5
3. Excess throat mucus or postnasal drip
0 1 2 3 4 5
4. Difficulty swallowing food, liquids, or pills
0 1 2 3 4 5
5. Coughing after you eat or after lying down
0 1 2 3 4 5
6. Breathing difficulties or episodes
0 1 2 3 4 5
7. Troublesome or annoying cough
0 1 2 3 4 5
8. Sensations of something sticking in your throat or a lump in your throat
0 1 2 3 4 5
9. Heartburn, chest pain, indigestion, or stomach acid coming up
0 1 2 3 4 5