Sandifer syndrome

Sandifer syndrome (or Sandifer's syndrome) is a paediatric medical disorder, characterised by gastrointestinal symptoms and associated neurological features There is a significant correlation between the syndrome and gastroesophageal reflux disease (GERD), however it is estimated to occur in less than 1% of children with reflux.

Symptoms and signs
Onset is usually confined to infancy and early childhood, with peak prevalence at 18–36 months. In rare cases, particularly where the child is severely mentally impaired, onset may extend to adolescence.

The classical symptoms of the syndrome are spasmodic torticollis and dystonia. Nodding and rotation of the head, neck extension, gurgling, writhing movements of the limbs, and severe hypotonia have also been noted.

Spasms may last for 1–3 minutes and may occur up to 10 times a day. Ingestion of food is often associated with occurrence of symptoms; this may result in reluctance to feed. Associated symptoms, such as epigastric discomfort, vomiting (which may involve blood) and abnormal eye movements have been reported. Clinical signs may also include anaemia.

Diagnosis
Diagnosis is made on the basis of the association of gastro-oesophageal reflux with the characteristic movement disorder. Neurological examination is usually normal. Misdiagnosis as benign infantile spasms or epileptic seizures is common, particularly where clear signs or symptoms of gastro-oesophageal reflux are not apparent. Early diagnosis is critical, as treatment is simple and leads to prompt resolution of the movement disorder.

Treatment
Successful treatment of the associated underlying disorder, such as GERD or hiatal hernia, may provide relief.

Prognosis
Sandifer syndrome is not typically life-threatening and prognosis is good.