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Sandifer syndrome is defined by abnormal neurobehavioral movements in the context of hiatal hernia or gastroesophageal reflux disease (GERD) (1).
- Abnormal movements are often temporally associated with feedings and include the following:
- Head/eye version
- Extensor spasm
- Dystonic posturing
- Minimal jerking of the extremities
- Sandifer syndrome is underrecognized.
- Occurs in <1% of pediatric patients with GERD (1)
- Most common in male children, although infants and girls can be affected. Adult cases are rare.
- Commonly misdiagnosed as epilepsy (2)
Etiology and Pathophysiology
Movements are hypothesized to be a vagally mediated reflex response to esophageal acid exposure (3). The eosinophilic esophagitis from cow’s milk protein allergy may also be a cause of Sandifer syndrome (4).
Commonly Associated Conditions
- Cognitive impairment in older children and adults
- Hiatal hernia (1)