Sindrome de sandifer: a propósito de la enfermedad por reflujo gastroesofágico en niños / Sandifer syndrome and gastroesophageal reflux in childre

El Síndrome de Sandifer es un trastorno neuroconductual con movimientos de hiperextensión de cuello, cabeza y tronco, con rotación de cabeza, que generalmente se presentan durante o inmediatamente después de la ingesta de alimentos y cesa durante el sueño, secundario a enfermedad por reflujo gastroesofágico. Se caracteriza por esofagitis, anemia por deficiencia de hierro y son confundidos con frecuencia como crisis de origen epiléptico. Lactante masculino de 5 meses referido por movimientos de tónico-clónicos generalizados, de segundos de duración, con una frecuencia de 30 episodios al día, que no ceden con el uso de 3 anticonvulsivantes. Disfagia a alimentos pastosos. Hospitalización al mes de vida por episodio de amenazante de la vida. Estudios neurológicos normales. Paraclínica: anemia microcítica e hipocrómica. Videodeglutoscopia: Disfagia de fase oral leve, disfagia fase esofágica a estudiar (Regurgitación), reflujo faringolaringeo según escala de Belafsky y Larigomalacia grado I; pHmetría de 24 horas con impedancia, puntación de Boix-Ochoa de 26%, durante la colocación de la sonda se observo posición anómala de la cabeza e hiperextensión del dorso. Estudio contrastado de esófago, estómago y duodeno sin anormalidad anatómica. Endoscopia digestiva superior: Esofagitis no erosiva, Hernia hiatal. El Síndrome de Sandifer es una de las presentaciones atípicas de RGE en lactantes. Amerita la evaluación de un equipo multidisciplinario para establecer el diagnóstico. El manejo medico incluyó medidas antireflujo, esomeprazol y técnica de alimentación adecuada con evolución satisfactoria. La diversidad de enfermedades relacionadas con RGE exige el uso de variadas técnicas para lograr diagnósticos más asertivos

Sandifer's syndrome is a neurobehavioral disorder with hyperextension movements of neck, head and trunk, head rotation, which usually occur during or immediately after food intake and ceases during sleep, secondary to gastroesophageal reflux disease. It is characterized by esophagitis, anemia and iron deficiency are often confused as a crisis of epileptic origin. A male infant of 5 months reported by tonic-clonic movements of widespread, lasting seconds, with a frequency of 30 episodes per day, which do not yield with the use of 3 anticonvulsants. Pasty food dysphagia. Hospitalization month of life-threatening episode of life. Normal neurological studies. Paraclinical: hypochromic microcytic anemia. Videodeglutoscopia: mild oral phase dysphagia, esophageal dysphagia to study phase (regurgitation), pharyngolaryngeal reflux as Belafsky and Larigomalacia scale grade I, ph-metry of 24 hours with impedance, Boix-Ochoa score of 26% during the placement of probe was observed abnormal head position and hyperextension of the back. Contrast study of esophagus, stomach and duodenum without anatomical abnormality. Upper gastrointestinal endoscopy: nonerosive esophagitis, hiatal hernia. Sandifer Syndrome is one of the atypical presentations of GER in infants. Warrants evaluation by a multidisciplinary team to establish the diagnosis. The medical management included antireflux measures, esomeprazole and proper feeding technique with satisfactory outcome. The diversity of diseases associated with GER requires the use of various diagnostic techniques to get more assertive

Síndrome de Sandifer: associação entre movimentos e posturas anormais e refluxo gastresofágico / Sandifer's Syndrome: association between abnormal postures and movements and gastroesophageal reflux

Apresentação de um caso de síndrome de Sandifer, que se caracteriza pela associação de posturas e movimentos anormais com refluxo gastresofágico. Os sinais e sintomas desta condição são, em geral, erroneamente atribuídos a problemas neurológicos, o que acarreta a exposição das crianças afetadas a procedimentos desnecessários, não raramente caros e invasivos e, freqüentemente, à prescrição de drogas ineficazes e não isentas de efeitos colaterais importantes. Criança com 9 meses de idade que vem apresentando, há cerca de 1 mês, episódios de curta duração em que vira o rosto para o lado esquerdo, eleva o ombro do mesmo lado e, mais raramente, apresenta postura tônica de todo o hemicorpo deste lado. Os episódios chegam a se repetir até seis vezes ao dia apresentando-se, por vezes, em salvas. Durante os episódios a criança parece não ter comprometimento da consciência. Após diagnóstico de epilepsia com crises parciais, vem recebendo medicação anticonvulsivante, tendo apresentado, segundo a mãe, discreta melhora. Embora os informantes tenham negado a existência de fatores desencadeantes, após interrogatório direto referiram que a criança apresentou, no passado, refluxo gastresofágico e admitiram que talvez houvesse certa relação temporal das “crises” com os horários da alimentação. Uma vez que as “crises” descritas pelos familiares não tinham características claramente epilépticas, havia a associação temporal com os horários da alimentação e tratava-se de criança que havia apresentado refluxo gastresofágico, a suspeita diagnóstica aventada e posteriormente confirmada foi de síndrome de Sandifer.

Presentation of one case of Sandifer's syndrome which is characterized by the association between abnormal movements and postures and gastroesophageal reflux. Signs and symptoms of this condition are usually erroneously attributed to neurological problems, resulting in the exposition of the involved children to unnecessary expansive and invasive procedures, and frequently to the prescription of inefficient drugs not free from important adverse effects. Nine months old child presenting in the last month short duration episodes of turning the face to the left side, elevating the shoulder of the same side and, more rarely, presenting tonic posture of all this side of the body. The episodes are repeated up to six times a day as volley, during which the child seems to have the consciousness preserved. After partial seizures epilepsy diagnosis, the child has been receiving antiepileptic drugs, and has presented discrete improvement, as to the mother. Although outbreaking factors have been denied by the parents, they referred that the child had presented gastroesophageal reflux in the past and admitted certain relation between the "seizures" and the feeding times. Since the "seizures" described by the parents were not clearly characterized as epileptic ones, and were associated with feeding times, and the child had presented gastroesophageal reflux, Sandifer's syndrome was the most likely suspected diagnosis in fact further confirmed.

A Case of Sandifer Syndrome

Sandifer syndrome is a rare manifestation of gastroesophageal reflux in children, occurring in association with abnormal movement of the head and neck and recurrent episodes of seizure after feeding. This syndrome may be misdiagnosed as infantile seizure and musculoskeletal disorder and may be associated with failure to thrive, anemia, aspiration pneumonia, and esophagitis. In this paper, Sandifer syndrome in a four months old male with recurrent aspiration pneumonia, apnea, and seizure after feeding is presented.