Gastroenterology — MCQs

Q: Sandifer syndrome due to GERD in infants is confused with which of the following conditions?

Seizures. **Explanation:** **Sandifer syndrome** is a paroxysmal movement disorder associated with **Gastroesophageal Reflux Disease (GERD)** in infants and young children. It is characterized by abnormal posturing of the head, neck, and trunk (torticollis and opisthotonus) during or immediately after feeding. **Why Seizures is the correct answer:** The classic presentation involves sudden, repetitive episodes of arching the back and tilting the head to one side. These movements are often mistaken for **infantile spasms or focal seizures**. The underlying mechanism is a physiological response where the child assumes these positions to lengthen the esophagus and increase the lower esophageal sphincter pressure, thereby reducing the pain caused by acid reflux. Because the movements are episodic and paroxysmal, they frequently lead to unnecessary neurological workups (like EEGs) before the GI cause is identified. **Why other options are incorrect:** * **Recurrent vomiting:** While vomiting is a symptom of GERD, it is the *clinical manifestation* of the reflux itself, not a condition that the specific "posturing" of Sandifer syndrome is confused with. * **Acute otitis media & Sinusitis:** While chronic GERD can lead to ENT complications (like recurrent ear infections) due to micro-aspiration or Eustachian tube dysfunction, these conditions do not present with the paroxysmal motor movements that mimic neurological disorders. **High-Yield Clinical Pearls for NEET-PG:** * **Triad of Sandifer Syndrome:** GERD, Hiatus hernia (often present), and abnormal posturing (Torticollis/Opisthotonus). * **Diagnosis:** Primarily clinical; confirmed by pH monitoring or improvement with anti-reflux therapy (PPIs). * **Key Differentiator:** Unlike seizures, Sandifer syndrome episodes are strictly associated with feeding and are not accompanied by post-ictal confusion or abnormal EEG activity.

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