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Sandifer syndrome posturing: relation to abdominal wall contractions, gastroesophageal reflux, and fundoplication
Eric A Frankel1, Theresa M Shalaby, Susan R Orenstein
1University of Pittsburgh Medical Center-St. Margaret, Pennsylvania 15213-2583, USA.
Insights
Sandifer syndrome, characterized by abnormal posturing, may be triggered by abdominal contractions leading to gastroesophageal reflux. Surgical intervention like fundoplication can resolve this condition, even without typical reflux symptoms.
Area of Science:
- Pediatric Gastroenterology
- Neurology
Background:
- Sandifer syndrome involves abnormal posturing in children with gastroesophageal reflux (GER).
- The precise mechanisms linking GER, abdominal contractions, and Sandifer syndrome posturing remain incompletely understood.
Observation:
- A detailed case study of a child with Sandifer syndrome was conducted.
- Utilized esophageal pH monitoring, surface electromyography, and videography to analyze physiological data.
Findings:
- A significant association was found between rectus abdominis muscle contractions and the onset of reflux episodes (P < 0.001).
- Reflux episodes were also strongly associated with Sandifer syndrome's characteristic posturing.
- These findings suggest abdominal wall contractions may precipitate GER.
Implications:
- Sandifer syndrome can occur due to GER even without hiatal hernia, esophagitis, or overt reflux symptoms.
- Fundoplication surgery may effectively treat Sandifer syndrome, even in cases resistant to medical management.
Abstract:
Sandifer syndrome designates abnormal posturing in patients with gastroesophageal reflux. To explore its mechanisms via examining relationships among Sandifer syndrome posturing, abdominal wall contractions, and reflux episodes, we studied an affected child in detail. The study utilized esophageal pHmetry, surface electromyography, and split-screen videography. The multichannel physiologic study demonstrated association of rectus abdominis contraction with onset of reflux episodes (P < 0.001) and association of reflux episodes with Sandifer syndrome posturing. This child's subsequent course confirmed his diagnosis and suggested mechanisms of the association of reflux and Sandifer syndrome. We conclude that abdominal wall contractions may induce reflux episodes. Sandifer syndrome may be due to gastroesophageal reflux even without hiatal hernia, macroscopic esophagitis, or reflux symptoms. Despite the absence of more typical reflux symptoms and failure to respond to very aggressive medical therapy, Sandifer syndrome may resolve after fundoplication.
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