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Pancreatic Exocrine Insufficiency Questionnaire
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Pancreatic Exocrine Insufficiency Questionnaire
Pancreatic Exocrine Insufficiency Questionnaire
Abdominal symptoms
Bowel movement symptoms
Impacts
1
In the past 7 days, did you have stomach pains?
Please make a choice
No, not at all (0)
Yes, a little bit (1)
Yes, some (2)
Yes, quite a bit (3)
Yes, a lot (4)
2
In the past 7 days, did you feel bloated (your stomach feeling tight and full)?
Please make a choice
No, not at all (0)
Yes, a little bit (1)
Yes, some (2)
Yes, quite a bit (3)
Yes, a lot (4)
3
In the past 7 days, did your stomach make noises?
Please make a choice
No, not at all (0)
Yes, a little bit (1)
Yes, some (2)
Yes, quite a bit (3)
Yes, a lot (4)
4
In the past 7 days, did you pass gas?
Please make a choice
No, not at all (0)
Yes, a little bit (1)
Yes, some (2)
Yes, quite a bit (3)
Yes, a lot (4)
5
In the past 7 days, when you passed gas did it smell very bad?
Please make a choice
No, not at all (0)
Yes, a little bit (1)
Yes, some (2)
Yes, quite a bit (3)
Yes, a lot (4)
6
In the past 7 days, did you feel sick (but didn’t actually vomit/throw up)?
Please make a choice
No, not at all (0)
Yes, a little bit (1)
Yes, some (2)
Yes, quite a bit (3)
Yes, a lot (4)
7
In the past 7 days, did you have a lack of appetite?
Please make a choice
No, not at all (0)
Yes, a little bit (1)
Yes, some (2)
Yes, quite a bit (3)
Yes, a lot (4)
8
In the past 7 days, did you have diarrhoea (watery poo)?
Please make a choice
No, not at all (0)
Yes, a little bit (1)
Yes, some (2)
Yes, quite a bit (3)
Yes, a lot (4)
9
In the past 7 days, did you feel the need to rush to the toilet to have a bowel movement (have a poo)?
Please make a choice
No, not at all (0)
Yes, a little bit (1)
Yes, some (2)
Yes, quite a bit (3)
Yes, a lot (4)
10
In the past 7 days, did your poo look lighter or orange in colour?
Please make a choice
No, not at all (0)
Yes, a little bit (1)
Yes, some (2)
Yes, quite a bit (3)
Yes, a lot (4)
11
In the past 7 days, when you had a poo did it smell very bad?
Please make a choice
No, not at all (0)
Yes, a little bit (1)
Yes, some (2)
Yes, quite a bit (3)
Yes, a lot (4)
12
In the past 7 days, did you see or have fat or oil in your poo or on the toilet paper?
Please make a choice
No, not at all (0)
Yes, a little bit (1)
Yes, some (2)
Yes, quite a bit (3)
Yes, a lot (4)
13
In the past 7 days, did you feel you needed to be close to a toilet because of your enzyme problem?
Please make a choice
No, not at all (0)
Yes, a little bit (1)
Yes, Moderately (2)
Yes, quite a bit (3)
Yes, extremely (4)
14
In the past 7 days, did you avoid fatty foods?
Please make a choice
No, not at all (0)
Yes, a little of the time (1)
Yes, sometimes (2)
Yes, most of the time (3)
Yes, all of the time (4)
15
In the past 7 days, did your enzyme problems affect your ability to concentrate?
Please make a choice
No, not at all (0)
Yes, a little of the time (1)
Yes, sometimes (2)
Yes, most of the time (3)
Yes, all of the time (4)
16
In the past 7 days, did you feel embarrassed going to the toilet because of your enzyme problems?
Please make a choice
No, not at all (0)
Yes, a little bit (1)
Yes, Moderately (2)
Yes, quite a bit (3)
Yes, extremely (4)
17
In the past 7 days, did you feel worried, anxious or stressed because of your enzyme problems?
Please make a choice
No, not at all (0)
Yes, a little bit (1)
Yes, Moderately (2)
Yes, quite a bit (3)
Yes, extremely (4)
18
In the past 7 days, did your enzyme problems affect your social activities?
Please make a choice
No, not at all (0)
Yes, a little of the time (1)
Yes, sometimes (2)
Yes, most of the time (3)
Yes, all of the time (4)
Next
Have you been diagnosed with PEI
before?
No
Yes
Next
