GERD-HRQL: what the ten questions ask, how the score adds up and what it cannot tell you

Your clinic may ask you to fill in the GERD-HRQL, a short reflux questionnaire. On paper you add up the points yourself; the reflux diary in Sam asks it as a monthly check-in and puts your scores into the doctor report PDF. This guide explains what the ten questions ask, how the total adds up and what it cannot tell you.

What is the GERD-HRQL?

GERD-HRQL stands for Gastroesophageal Reflux Disease Health-Related Quality of Life. Vincent Velanovich first described it in 1996. His aim was a simple number for reflux symptoms, because only the patient can say how bad they are. In the first study, 72 people referred for reflux filled it in. All of them completed it.

In 1998 Velanovich compared it with the SF-36, a general health questionnaire, in 43 people with reflux. The GERD-HRQL total was the only significant predictor of how satisfied they were with their reflux symptoms. 86 percent said it reflected their symptoms better than the SF-36.

Since then it has been used to compare symptoms before and after medication, endoscopic procedures and surgery. A 2023 review by Velanovich found 767 published articles from 53 countries that used it. It counted eight validated translations and many informal ones.

What do the ten questions ask?

We describe the questions in our own words here. The form itself gives the exact wording.

Six questions are about heartburn. They ask how bad it is overall and whether it comes when you lie down, when you stand up and after meals. They also ask whether it changes your diet and whether it wakes you at night. Two ask about swallowing: whether it is difficult and whether it hurts. One asks about feeling gassy or bloated. The last asks whether reflux medicine, if you take it, affects your daily life.

A lump feeling in the throat is not one of the questions. How it relates to reflux is covered in globus sensation and reflux.

Every question uses the same six answers:

• 0: no symptoms
• 1: you notice them, but they do not bother you
• 2: they bother you, but not every day
• 3: they bother you every day
• 4: they affect your daily activities
• 5: they are so bad that you cannot do your daily activities

Many paper forms add a separate question on how satisfied you are with your present condition. You answer satisfied, neutral or dissatisfied. That answer is not part of the score.

How do you add up your score?

Add the ten answers. The total runs from 0 to 50, and a higher number means more or stronger symptoms. The name says "quality of life", where higher often means better. Here lower is better.

Velanovich points out that the scale has 51 possible scores. In his data, only 4 of 372 patients reached the top score of 50.

An example with invented numbers: you rate the six heartburn questions 3, 2, 1, 3, 2 and 2. Swallowing gets 0 and 0, bloating gets 2, and the medicine question gets 1. Your total is 16 out of 50. Write the date next to it. The next score only means something next to this one.

Why do some forms add up to 75?

Not every GERD-HRQL form looks the same. Some clinics use a longer version with six extra questions on regurgitation, when stomach contents come back up. One clinic form of this kind has 15 scored questions and asks about the past two weeks. It drops the bloating question, adds up to 75 and has subscores for heartburn and regurgitation. Other forms keep the ten-question total of 50 and print the regurgitation questions as an extra block.

Scores from different versions are not directly comparable. If your practice gives you a form, note which version it is. Then keep using the same one.

What does your GERD-HRQL score mean?

The sources read for this guide publish no official bands such as mild, moderate or severe. They also give no normal value for the general population. Velanovich built the questionnaire to compare a person's scores over time, for example before and after a change in therapy.

The first study gives a sense of scale. People who were satisfied with their condition had a median score of 5. Those who were dissatisfied had a median of 26. That early version had a maximum of 45 points. These are group values from one study, not a cut-off for you.

The score records what you report. In the first study, it did not correlate with pH measurements. So it cannot stand in for an endoscopy or a 24-hour pH test. What your number means for your therapy is for you and your doctor to discuss.

How Sam uses the GERD-HRQL

In Sam, the questionnaire belongs to the reflux program, that is its own diary with a doctor report and a monthly questionnaire. You start it once you confirm in the app that a doctor found reflux. The first check-in is your baseline. After that, Sam asks the same ten questions every 30 days and sends a reminder when the next one is due.

Sam uses the ten-question version with its total of 0 to 50. It leaves out the satisfaction question and the extra regurgitation block. You log regurgitation as an episode in the diary instead. The English wording stays close to the published forms; the diet question, for example, asks whether heartburn changes what you eat. The German questions use the wording of a German hospital form.

After each check-in, Sam shows your score out of 50. It compares the score with your last check-in and with your baseline. It also shows one of four labels: Minimal, Mild, Troublesome or High burden. These labels are Sam's own split of the range into four equal parts, at 12, 25 and 38 points. They are descriptive, not clinical cut-offs. Sam calls a change of 8 points or more "notable". That threshold is also Sam's own, not a published value.

The doctor report has a section called "GERD-HRQL over time". It shows your latest score with its label and up to 12 check-ins from the period you choose. Once you have two check-ins, a chart is added. A note says that the bands are descriptive and not a clinical diagnosis. You choose 1, 3, 6 or 12 months or your whole record, and you bring the PDF yourself.

The diary holds your reflux episodes: type, intensity, foods, circumstances such as a late meal, and whether it woke you at night. After five entries, Sam shows how often your own food and circumstance tags come up. No diagnosis yet? Then your symptoms go into the symptom diary.

When should symptoms not wait for the next check-in?

A monthly score is for slow changes. Some symptoms need a doctor sooner. The NHS advises seeing a GP if you have heartburn most days or if pharmacy medicines do not help. The same goes for food getting stuck in your throat, vomiting often or losing weight without trying. IQWiG, Germany's health information institute, also names signs of bleeding, such as blood in the stool, as a reason for an early endoscopy.

Chest pain is different. According to the NHS, sudden chest pain that does not go away can feel like burning or indigestion. It may be a heart attack, as may pain that spreads to your arm, neck, jaw, stomach or back. Sweating, nausea, light-headedness or shortness of breath with chest pain count too. Then call your local emergency number (112 in the EU, 999 in the UK, 911 in the US). This is general information, not a diagnosis.

Record your GERD-HRQL check-ins in Sam and bring the trend as a PDF

You bring your GERD-HRQL scores to the appointment as a dated trend, not as one number from memory.

• Instead of a paper form: the reflux diary in Sam asks the ten questions every 30 days and adds up the score for you.
• Instead of loose sheets: each score is compared with your last check-in and your baseline, so you see the change in points.
• Instead of a summary from memory: the doctor report PDF shows your GERD-HRQL over time in the same report as your reflux episodes.
• Instead of guessing: after five entries, Sam shows how often your own food and circumstance tags come up.

Sam records what you enter. The diary starts once you confirm that a doctor found reflux, and Sam's labels are not clinical cut-offs.

Try Sam for free

Sam is a wellness companion, not a medical device. The app does not diagnose, treat, cure or prevent any condition or health state. Always consult qualified professionals for medical decisions.

Related reading

• What to include in a doctor report
• How to use the MIDAS migraine questionnaire
• How to use the GINA-based asthma symptom check

Sources

Updated: October 2026

• Velanovich V, Vallance SR, Gusz JR, Tapia FV, Harkabus MA: Quality of life scale for gastroesophageal reflux disease. J Am Coll Surg 1996;183:217-224. PubMed 8784314 (abstract read)
• Velanovich V: Comparison of generic (SF-36) vs. disease-specific (GERD-HRQL) quality-of-life scales for gastroesophageal reflux disease. J Gastrointest Surg 1998;2(2):141-145. PubMed 9834409 (abstract read)
• Velanovich V: The development of the GERD-HRQL symptom severity instrument. Dis Esophagus 2007;20(2):130-134. PubMed 17439596 (abstract read; the GERD-HRQL is credited to this author)
• Velanovich V: 25 years of the GERD-HRQL symptom severity instrument: an assessment of published applications. Surg Endosc 2023;37(1):255-265. PubMed 35920907 (abstract read)
• Merit Medical: TIF GERD-HRQL questionnaire (PDF, example of the ten-question form with a 50-point total and an extra regurgitation block)
• Ventura Bariatrics: GERD-HRQL questionnaire (PDF, example of a 15-question form with a 75-point total)
• NHS: Heartburn and acid reflux (last reviewed 20 November 2023)
• NHS: Chest pain (last reviewed 8 August 2023)
• IQWiG, Gesundheitsinformation.de: Wie wird eine Refluxkrankheit festgestellt? (German, updated 31 July 2024)