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| Do you have gnawing pain / burning in the stomach? | |
Between meals? | |
Middle of the night? | |
| What types of food do you avoid? | |
| Have you ever vomited up blood? | |
| Any recent change in bowel habits? | |
| Frequency of loose bowel movements? | |
| Problems with constipation? | |
| Ever have black tarry bowel movements? | |
| Excessive gas in your stomach? | |
| Ever had bright red bleeding from the rectum? | |
| Do you have pain with bowel movements? |