Gastrointestinal Symptom Rating Scale (GSRS)
What it is
The GSRS is a 15-item self-report questionnaire assessing the severity of common gastrointestinal (GI) symptoms over the past week. It was originally developed for use in clinical trials involving patients with irritable bowel syndrome (IBS) and peptic ulcer disease, and has since been widely validated across a range of GI conditions including gastroesophageal reflux disease (GERD) and functional dyspepsia.
The GSRS is particularly relevant in mental health settings given the established relationship between psychological distress and gastrointestinal functioning. It provides a standardised, quantifiable measure of symptom burden that can be monitored alongside mental health outcomes.
How is it used
- Suitable for adults aged 18 and over
- Takes approximately 5–10 minutes to complete
- Assesses GI symptoms experienced over the past week
- Can be used at baseline and follow-up to track symptom change over time
- Requires permission for use from AstraZeneca R&D prior to administration
The 15 items are grouped into five symptom domains (subscales):
- Reflux — heartburn and acid regurgitation
- Abdominal pain — stomach pain and hunger pains
- Indigestion — nausea, bloating, belching, and taste disturbance
- Diarrhoea — loose stools, urgency, and incomplete evacuation
- Constipation — constipation, hard stools, and sensation of incomplete emptying
What do the scores mean?
Each of the 15 items is rated on a 7-point Likert scale from 1 (no discomfort) to 7 (very severe discomfort). Total scores range from 15 to 105, with higher scores indicating greater GI symptom severity.
Domain scores are calculated by averaging the item scores within each subscale, giving a range of 1 to 7 per domain. Higher domain scores indicate more severe symptoms in that area.
There are no established clinical cut-off scores for the GSRS — interpretation is based on the level of symptom severity across domains and changes over time rather than threshold-based categories. Statistically significant differences in GSRS scores have been observed between treatment responders and non-responders, supporting its use as a measure of treatment response.
Developer
The GSRS was originally developed by Svedlund, Sjödin, and Dotevall (1988). The self-report version was later revised and validated by Revicki and colleagues. The copyright holder is AstraZeneca R&D.
References:
Svedlund, J., Sjödin, I., & Dotevall, G. (1988). GSRS — A clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Digestive Diseases and Sciences, 33(2), 129–134.
Revicki, D. A., Wood, M., Wiklund, I., & Crawley, J. (1998). Reliability and validity of the Gastrointestinal Symptom Rating Scale in patients with gastroesophageal reflux disease. Quality of Life Research, 7(1), 75–83.
Kulich, K. R., Madisch, A., Pacini, F., Piqué, J. M., Regula, J., Van Rensburg, C. J., Újszászy, L., Carlsson, J., Halling, K., & Wiklund, I. K. (2008). Reliability and validity of the Gastrointestinal Symptom Rating Scale (GSRS) and Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire in dyspepsia: A six-country study. Health and Quality of Life Outcomes, 6, 12.