SIBO Questionnaire 

1. In the last 3 months, how often did you have discomfort or pain anywhere in your abdomen?
   (If your answer is NEVER, please skip to Question7.)
   1. All the time   3
   2. Most of the time   2
   3. Sometimes   1
   4. Never   0
2. Have you had this discomfort or pain for 6 months or longer?
   1. No   0
   2. Yes   1
   3. Longer than 12 months  2
3. (Women Only) Did this discomfort or pain occur only near or during your menstrual period and not at other times?
   1. Yes      0
   2. No       1
4. How often did this discomfort or pain get better or stop after you had a bowel movement?
   1. Never  0
   2. Sometimes 1
   3. Most of the time 2
5. When this discomfort or pain started, were your stools looser?
   1. No  0
   2. Yes  1
6. When this discomfort or pain started, were your stools harder?
   1. No  0
   2. Yes  1
7. Within the past 12 months prior to the onset of your symptoms, did you have gastroenteritis (ie. food poisoning, vomiting & diarrhea, traveller’s diarrhea)?
   1. No   0
   2. Yes   2
8. In the last 3 months, how often did you have hard, lumpy stool?
   1. Never  0
   2. Sometimes 1
   3. Most of the time 2
9. In the last 3 months, how often did you have loose, watery stool?
   1. Never  0
   2. Sometimes 1
   3. Most of the time 2
10. In the last 3 months, how often did you have difficulty having a bowel movement (straining, feeling that you have not finished)?
    1. Never  0
    2. Sometimes 1
    3. Most of the time 2
11. In the last 3 months, how often did you feel bloated after meals?
    1. Never  0
    2. Sometimes 1
    3. Most of the time 2
12. In the last 3 months, how often did you belch, especially after meals?
    1. Never  0
    2. Sometimes 1
    3. Most of the time 2
13. In the last 3 months, how often did you feel that you had a problem with passing too much gas?
    1. Never  0
    2. Sometimes 1
    3. Most of the time 2
14. How often did you have gastroesophageal acid reflux (GERD)?
    1. Never  0
    2. Sometimes 1
    3. Most of the time 2
15. How often did you have steatorrhea (fatty stool – pale, bulky, foul-smelled, floating)?
    1. Never  0
    2. Sometimes 1
    3. Most of the time 2
16. Were you on any of the following medications: proton pump inhibitor, opioids, and or NSAIDs?
    1. No  0
    2. Yes 2
17. Did soluble fiber/prebiotics intake worsen your GI symptoms?
    1. No  0
    2. Yes 2
18. If you had been on antibiotics recently lately, did it help improve your GI symptoms?
    1. No 0
    2. Yes 1 
19. Have you been diagnosed with rosacea/acne rosacea?
    1. No  0
    2. Yes 2
20. Have you been diagnosed with Celiac disease or Inflammatory Bowel Disease (UC & Crohn’s)?
    1. No  0
    2. Yes 1
21. Do you have skin rashes, such as eczema and psoriasis?
    1. No  0
    2. Yes 1

SCORING:
Add up total scores:

• Score 23-29: you are likely suffering from SIBO
• Score 13-22: you may be suffering from SIBO, but other conditions are also possible
• Score <13: your symptoms may not be due to SIBO, and other conditions should be considered.