Gastroesophageal reflux and torticollis.

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Abstract
The Sandifer syndrome is a combination of hiatal hernia and abnormal posturing of the head and neck. The abnormal posturing has been attributed to an attempt to decrease the pain of esophagitis resulting from gastroesophageal reflux and hiatal hernia. Five patients were seen with a variant of the Sandifer syndrome: gastroesophageal reflux, esophagitis and torticollis, but no hiatal hernia. In each patient, following fundoplication the torticollis disappeared, with the return of normal motion and appearance of the head and neck. Even in the absence of a complete Sandifer syndrome with hiatal hernia, gastroesophageal reflux and accompanying esophagitis can cause a torticollis. Surgical management of the reflux by fundoplication results in the disappearance of the torticollis. Since torticollis is a common problem in infancy, evaluation for gastroesophageal reflux should be performed if no other cause can be found.