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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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

We report three children with benign paroxysmal torticollis (BPT) and review the literature. BPT represents a self-limited disorder that occurs mainly in infancy and in females. The condition is characterized by recurrent spells of torticollis which may, or may not, be accompanied by other symptoms such as vomiting, pallor, ataxia, irritability and drowsiness. The diagnosis of BPT should be established clinically, although, in some cases, it is necessary to rule out conditions such as posterior fossa tumor, cervical dislocation, ocular palsy, dystonia due to side effects of drugs, or Sandifer's syndrome. The etiology of the syndrome remains unknown and, at present, there is no effective therapy.
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PMID:[Benign infantile paroxysmal torticollis. Apropos of 3 cases]. 305 50

A girl aged 4 years and 5 months was admitted because of vomiting, poor appetite, epigastrial pain, weight loss and an abnormal posturing of the head and neck since the age of 3 1/2 years. This abnormal posturing consisted of maximal lateral flexion of the head and neck to the left. A number of investigations including EEG and CT-Scan of the head, had been performed repeatedly, and despite normal results various neuropsychiatric diagnoses were made. In our hospital massive gastrooesophageal reflux and oesophagitis were demonstrated and the diagnosis of Sandifer's syndrome was established. A fundoplication was performed and the child is free of symptoms since.
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PMID:[Dystonia as a complication of gastroesophageal reflux: Sandifer syndrome]. 343 9

One hundred children underwent Nissen's fundoplication for complications of gastroesophageal reflux. Indications for fundoplication included refractory pneumonia, apneic spells, intractable vomiting, failure to thrive, esophagitis, esophageal stricture, and Sandifer's syndrome. Except for those with life-threatening complications, fundoplication was performed only in those who had failure with a strict medical antireflux regimen. Four patients were not helped by operation or had a recurrence of symptoms. Of these, three with refractory pneumonia were judged to be failures of selection since reflux was absent postoperatively. The fourth had massive reflux and recurrent vomiting. Eight other patients had radiologic evidence of reflux postoperatively. Six of these were asymptomatic and two had minor symptoms. There was one death and 11 postoperative complications.
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PMID:Surgical treatment of gastroesophageal reflux in children. Results of Nissen's fundoplication in 100 children. 742 52

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

We report a 27 year-old man with intellectual disability and no prior history of seizures who presented with episodes of abdominal pain, head/eye version and unresponsiveness that were misdiagnosed and treated as partial seizures. Associated vomiting and haematemesis led to the correct diagnosis and treatment of reflux oesophagitis. The episodes immediately resolved and a diagnosis of Sandifer syndrome was made. This is only the second report of Sandifer syndrome in adult, a movement disorder of unknown mechanism that occurs almost exclusively in young children, often misdiagnosed as epilepsy or episodic dystonia. (Published with videosequences).
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PMID:Sandifer syndrome misdiagnosed as refractory partial seizures in an adult. 1507 69

Torticollis is a clinical symptom and sign characterized by a lateral head tilt and chin rotation toward the side opposite to the tilt. Many conditions cause torticollis. The differential diagnosis is different for infants than for children and adolescents. Congenital muscular torticollis associated with a contracture of the sternocleidomastoid muscle is the most common etiology of torticollis in infants. The condition of most infants with congenital muscular torticollis improves with a regimen of manual cervical stretching. Congenital anomalies of the occipital condyles and upper cervical spine must be ruled out before performing a release of the sternocleidomastoid muscle in a child who fails to improve with physical therapy. Unusual nonmuscular causes of torticollis in the infant also must be considered and include ocular torticollis caused by eye muscle weakness, Sandifer's syndrome resulting from gastroesophageal reflux, neural axis abnormalities, and benign paroxysmal torticollis. Torticollis in the older child is most frequently a manifestation of atlantoaxial rotatory displacement resulting from trauma or oropharyngeal inflammation (Grisel's syndrome). Retropharyngeal abscesses and pyogenic cervical spondylitis are unusual infectious causes of torticollis. Intermittent torticollis associated with headaches, vomiting, or neurologic symptoms may be caused by tumors of the posterior fossa. Benign and malignant neoplasms of the upper cervical spine are rare causes of torticollis in children. Torticollis resulting from cervical dystonia is also rare in children but may be seen in older adolescents.
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PMID:Torticollis in infants and children: common and unusual causes. 1695 98

Gastroesophageal reflux (GER) is defined as the involuntary retrograde passage of gastric contents into the esophagus with or without regurgitation or vomiting. It is a frequently experienced physiologic condition occurring several times a day, mostly postprandial and causes no symptoms. These infants are also called 'happy spitters'. GER disease (GERD) occurs when reflux of the gastric contents causes symptoms that affect the quality of life or pathologic complications, such as failure to thrive, feeding or sleeping problems, chronic respiratory disorders, esophagitis, hematemesis, apnea, and apparent life-threatening events. About 70-85 % of infants have regurgitation within the first 2 months of life, and this resolves without intervention in 95 % of infants by 1 year of age. The predominant mechanism causing GERD is transient lower esophageal sphincter (LES) relaxation, which is defined as an abrupt decrease in LES pressure to the level of intragastric pressure, unrelated to swallowing and of relatively longer duration than the relaxation triggered by a swallow. Regurgitation and vomiting are the most common symptoms of infant reflux. A thorough history and physical examination with attention to warning signals suggesting other causes is generally sufficient to establish a clinical diagnosis of uncomplicated infant GER. Choking, gagging, coughing with feedings or significant irritability can be warning signs for GERD or other diagnoses. If there is forceful vomiting, laboratory and radiographic investigation (upper gastrointestinal series) are warranted to exclude other causes of vomiting. Irritability coupled with back arching in infants is thought to be a non-verbal equivalent of heartburn in older children. Other causes of irritability, including cow's milk protein allergy, neurologic disorders, constipation and infection, should be ruled out. The presentation of cow's milk protein allergy overlaps with GERD, and both conditions may co-exist in 42-58 % of infants. In these infants, symptoms decrease significantly within 2-4 weeks after elimination of cow's milk protein from the diet. For non-complicated reflux, no intervention is required for most infants. Effective parental reassurance and education regarding regurgitation and lifestyle changes are usually sufficient to manage infant reflux. Sandifer syndrome, apnea and apparent life-threatening events are the extraesophageal manifestations of GERD in infants. Pharmacotherapeutic agents used to treat GERD encompass antisecretory agents, antacids, surface barrier agents and prokinetics. Currently, North American Society for Pediatric Gasroenterology, Hepatology and Nutrition (NASPGHAN) and European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) practice guidelines concluded that there is insufficient evidence to justify the routine use of prokinetic agents. Esomeprazole (Nexium) is now approved in the US for short-term treatment of GERD with erosive esophagitis in infants aged from 1 to 12 months. Although Nissen fundoplication is now well established as a treatment option in selected cases of GERD in children, its role in neonates and young infants is unclear and is only reserved for selective infants who did not respond to medical therapy and have life-threatening complications of GERD.
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PMID:Gastroesophageal reflux disease in neonates and infants : when and how to treat. 2332 52