Treatment of Sandifer Syndrome with an Amino-Acid–Based Formula

Abstract

Objective To study the presentation and treatment in two infants who presented with refractory Sandifer syndrome (SS).

Study Design We retrospectively reviewed the cases of two infants who presented to our outpatient clinic with SS who were refractory to conventional treatment.

Results We report two patients with refractory SS who responded to treatment with hypoallergenic formula.

Conclusion It is important to consider a diagnosis of milk protein allergy responsive to hypoallergenic formula in patients with SS who are refractory to conventional antireflux treatment.

Keywords

Sandifer syndrome - cow's milk protein allergy - pediatrics - GERD - infants

• References

• 1 Kinsbourne M. Hiatus hernia with contortions of the neck. Lancet 1964; 1 (7342) 1058-1061
• 2 Ramenofsky ML, Buyse M, Goldberg MJ, Leape LL. Gastroesophageal reflux and torticollis. J Bone Joint Surg Am 1978; 60 (8) 1140-1141
• 3 Williams CA, Frias JL. Apparent G syndrome presenting as neck and upper limb dystonia and severe gastroesophageal reflux. Am J Med Genet 1987; 28 (2) 297-302
• 4 Dias E, Ramachandra C, D'Cruz AJ, Yeshwanth M. An unusual presentation of gastro-oesophageal reflux—Sandifer's syndrome. Trop Doct 1992; 22 (3) 131
• 5 Olguner M, Akgür FM, Hakgüder G, Aktuğ T. Gastroesophageal reflux associated with dystonic movements: Sandifer's syndrome. Pediatr Int 1999; 41 (3) 321-322
• 6 Cavataio F, Iacono G, Montalto G , et al. Gastroesophageal reflux associated with cow's milk allergy in infants: which diagnostic examinations are useful?. Am J Gastroenterol 1996; 91 (6) 1215-1220
• 7 Hill DJ, Murch SH, Rafferty K, Wallis P, Green CJ. The efficacy of amino acid-based formulas in relieving the symptoms of cow's milk allergy: a systematic review. Clin Exp Allergy 2007; 37 (6) 808-822
• 8 Wolfe MM, Sachs G. Acid suppression: optimizing therapy for gastroduodenal ulcer healing, gastroesophageal reflux disease, and stress-related erosive syndrome. Gastroenterology 2000; 118 (2) (Suppl. 01) S9-S31
• 9 Puntis JW, Smith HL, Buick RG, Booth IW. Effect of dystonic movements on oesophageal peristalsis in Sandifer's syndrome. Arch Dis Child 1989; 64 (9) 1311-1313
• 10 Webb HE, Sutcliffe J. Neurological basis for the abnormal movements in Sandifer's syndrome. Lancet 1971; 2 (7728) 818
• 11 Kelly KJ, Lazenby AJ, Rowe PC, Yardley JH, Perman JA, Sampson HA. Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula. Gastroenterology 1995; 109 (5) 1503-1512