Background and aims Sandifer syndrome is a dystonic movement disorder described in children with severe gastro-oesophageal reflux. The authors proposed to establish a causal relationship between abnormal neurobehavioral attacks and gastro-esophageal reflux disease.

Methods Prospective observational study consisting of clinical evaluation for a period of six months and multidisciplinary investigations for 8 patients with postural dystonia.

Results 8 patients aged between 6 months and 36 months presenting postural dystonia have been studied in relation to gastro-esophageal reflux. In the clinical assessment of the patients, abnormal neurobehavioral attacks: head and cervical dystonic posture, extensor spasm and reflux suggestive symptoms: regurgitation, irritability, crying have been observed mainly after feedings. Neurological examination and ENT proved normal. Ultrasound study and esophagoendoscopy showed gastro-esophagial reflux and esophagitis in the absence of hiatus hernia. The patients received medical treatment to control the gastroesophagial reflux with gradual improvement and complete remission of the symptoms in all cases.

Conclusions Infants or children with dystonic posture and irritability should be evaluated for Sandifer Syndrome. Early diagnosis of the syndrome is essential, as effective treatment of the gastro-oesophageal reflux leads to resolution of the movement disorder.