24-hour oesophageal pH monitoring with a dual pH probe is considered to be the most sensitive test for diagnosing GORD-related otolaryngological manifestations. In this study we evaluate an initial diagnostic approach with digital videofluorography associated to the water siphon test and primary "ex juvantibus"
therapy with
proton pump inhibitors for patients with supra-oesophageal symptoms of GORD. The results of Nissen
fundoplication surgical treatment are also assessed in some of these patients. Two hundred and thirty patients with suspected GORD-related supra-oesophageal symptoms were referred for videofluorography and the water siphon test. When
hiatal hernia and/or reflux were found, patients were referred for medical
therapy with
proton pump inhibitors. Five patients, who had had a good or excellent response to the medical
therapy, but had a recurrence underwent laparoscopic Nissen
fundoplication and videofluorography 6 months after surgery. Within 6 months, more than 80% of patients had an excellent or good response to medical
therapy. In patients undergoing laparoscopic Nissen
fundoplication,
hoarseness and
chronic cough disappeared within 3 months and videofluorography showed good morphofunctional results of the surgery. In patients with GORD-related supra-oesophageal manifestations, videofluorography plus the water siphon test is useful initial investigation, and laparoscopic Nissen
fundoplication can be a valid alternative therapeutic option.