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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two infants with torticollis and hiatus hernia (Sandifer Syndrome) are presented. Both infants improved with medical management. Abnormal head and neck positioning is attributed to esophagitis secondary to gastroesophageal reflux, with or without hiatus hernia. Since esophagitis due to reflux is not necessarily accompanied by vomiting, infants with torticollis shoud be studied for gastroesophageal reflux. If present, medical management is usually successful.
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PMID:Torticollis with hiatus hernia in infancy. Sandifer syndrome. 85 42

Esophageal pH monitoring is recognized as the best diagnostic procedure for gastroesophageal reflux (GER) and operation is seldom recommended in the absence of abnormal pH data. To emphasize that operation should not be ruled out for children who may have false-negative pH studies, we report 14 patients operated on for GER in spite of normal pH-monitoring. The mean age was 54 months (range, 18 to 90). Clinical features included vomiting, dysphagia, respiratory disease, anemia, and torticollis. All had radiologic evidence of GER, and 10 had endoscopic and histological esophagitis. Conventional pH-monitoring values were normal but lower esophageal sphincter pressure and propulsive peristalsis were significantly decreased whereas nonpropulsive contractions were predominant. Operation was recommended after an average of 24 months of unsuccessful medical treatment. Independent postoperative assessment showed that 13 of the 14 patients were relieved of their symptoms and dysphagia persists in one. We suggest that the diagnosis of GER should be accepted on the basis of sound clinical judgement plus more than one abnormal test even when pH results are normal. Operation should not be withheld when clinically indicated. There are several explanations for false-negative pH studies, of which alkaline reflux is probably the most important and warrants further investigation in children.
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PMID:Surgery for gastroesophageal reflux in children with normal pH studies. 206 6

Extended esophageal pH-metering is the best method for GER diagnosis, but it has a certain number of false negatives. In a attempt to judge in which extent we can indicate surgery with a "normal" pH-metering study, we have reviewed our 110 operated children since 1982, and selected 12 in whom pH studies were normal. There where five females and seven males with ages ranging between 18 and 90 months. The clinical course until the diagnosis was accepted was long. Nine patients had vomiting, five respiratory disease, six dysphagia, four anemia and three torticollis. Only two were malnourished. There was radiologic GER in all children (with only one hiatal hernia). In spite of "normal" pH-metering, eight had decreased lower esophageal sphincter, and 11 disturbed motility. Nine had endoscopic esophagitis and eight histologic esophagitis. After operation, indicated only after long periods of medical treatment, vomiting disappeared in all, and so did respiratory disease and torticollis. Five families were very satisfied, six rather satisfied (gas bloat syndrome) and one frankly dissatisfied (dysphagia with severe immotility). Based on this evidence, we believe that some limited indications for surgery in GER are acceptable even in the presence of "normal" pH-studies.
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PMID:[False negatives in pH measurement. A retrospective study of 12 surgical cases]. 207 69

We report a case of Sandifer syndrome with chronic torticollis and gastroesophageal reflux (GER). The infant exhibited regurgitations and vomiting from birth. Torticollis with a permanent tilt of the head towards the right developed at age six months. At 16 months, persistence of the vomiting and abnormal attitude of the head and neck led to a CT scan that outruled a brain tumor. Esophageal pH recordings disclosed severe gastroesophageal reflux (pH less than 4 for 46% of the time over 24 hours) and endoscopy showed ulcerated peptic esophagitis. Surgical treatment of the GER ensured both resolution of the reflux and disappearance of the torticollis, establishing the causal relationship between the former and latter manifestations.
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PMID:[Torticollis in children: do not forget the Sandifer syndrome]. 231 62

A retrospective study based upon 100 consecutive antireflux operations performed in children for gastroesophageal reflux (GER) in the last 9 years enables the authors to elaborate on indications and their timing. The clinical pictures, often combined in this series, were vomiting (85%), respiratory disease (50%), failure to thrive (47%), haemorrhage (25%), brain damage (16%), rumination (6%), oesophageal stenosis (4%), torticollis (3%) and cricopharyngeal dysphagia (1%). Five children had been previously operated upon for oesophageal atresia. Hiatal hernia was found in only 10 instances. Only 9 children were operated upon before the age of 12 months. Overall operative age was high (52.5 months) and that of patients with neurologic disease was even higher (81.3 months) probably as a result of delayed diagnosis. This experience underlines the limitations of medical treatment beyond the age of 12 months, the poor reliability of disappearance of vomiting as an index of cure during the first year and the need for facing operative indications without prejudgements based on traditional ideas that do not take into consideration clinical manifestations of GER disease which are currently well established.
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PMID:[Indications for the surgery of gastroesophageal reflux in children]. 363 70

Sandifer syndrome is an unusual combination of gastroesophageal reflux with or without hiatal hernia and torticollis. It can be considered to be part of an expanded syndrome of unusual presentation of gastroesophageal reflux. After successful surgical repair of the gastroesophageal reflux and the hiatus hernia, there is a gradual but permanent disappearance of the torticollis. An infant with this extremely rare syndrome is presented along with a review of the related literature.
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PMID:Torticollis with hiatus hernia in children. Sandifer syndrome. 816 56

Gastroesophageal reflux is a common occurrence in infancy. The most severe complications of reflux include torticollis, opisthotonus, and paroxysmal dystonic posture (known as the Sandifer complex). We examined 17 patients now ranging in age from 9 months to 19 years (mean age 11 years) with the Brachmann-de Lange syndrome for evidence of gastroesophageal reflux and found that 13 had not only reflux, but also posturing and behavior consistent with the Sandifer complex. We propose that early recognition of gastroesophageal reflux in these patients may prevent the full picture of the Sandifer complex and allow for medical treatment rather than surgical intervention.
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PMID:Occurrence of the Sandifer complex in the Brachmann-de Lange syndrome. 829 18

The authors report a case of postural abnormality of the head and neck (Torticollis) in a fourteen month old infant with severe gastroesophageal reflux (GER). Disappearance of this abnormality after surgical correction of the reflux leads the authors to confirm the diagnosis of Sandifer's syndrome of which the main features are underlined. In its initial descriptions, Sandifer's syndrome was characterized by the sudden occurrence, usually during meals, of torticollis, consecutive to hiatal hernia in children. This torticollis disappears within days or weeks following surgical treatment of the hiatal hernia. It was later proved that the origin of the torticollis was not the hiatal hernia itself, but the consequent gastroesophageal reflux (GER).
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PMID:Sandifer's syndrome--a report of one case. 913 25

Sandifer syndrome is an uncommon clinical entity characterized by gastroesophageal reflux, torticollis and paroxysmal dystonic postures. For the wide variability in clinical expression it is diagnosed as neurological disease. We report on a 3-year-old patient who presented sudden extensions of the head and neck with tilting of the head one side and severe arching of the spine. It is presented a review of the related literature.
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PMID:[Sandifer's syndrome: a rare form of torticollis in childhood. A report of a patient]. 934 Jun 17

A 1.5-month-old boy with Sandifer's syndrome is described. After an uneventful delivery, he presented torticollis, seizure-like dystonic neck movements usually associated with feeding, episodic vomiting, inspiratory stridor and hand tremor in the first month of life. Barium esophagogram demonstrated gastroesophageal reflux, for which medical therapy was started. Children with torticollis and dystonic movements should be evaluated for Sandifer's syndrome. Early diagnosis and treatment of gastroesophageal reflux may prevent complications.
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PMID:A case of Sandifer's syndrome with hand tremor. 1176 69


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