Sandifer Syndrome Medication

  • Author: Pegeen Eslami, MD; Chief Editor: Carmen Cuffari, MD   more...
 
Updated: Apr 13, 2012
 

Medication Summary

Therapeutic response for the treatment of gastroesophageal reflux disease may take as long as 2 weeks. If treatment is successful, weight increases and vomiting episodes decrease.

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Prokinetic agents

Class Summary

These agents are used to augment cholinergic activity. Prokinetic pharmacotherapy is often used before acid suppression therapy in children without evidence of esophagitis because of the predominance of motility-related problems over increased acid (and regurgitation over pain) in the pathogenesis and presentation.

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Metoclopramide (Reglan)

 

Dopaminergic antagonist that works by increasing LES tone and gastric emptying. Stimulates muscular activity, leading to decrease in reflux.

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Antacids

Class Summary

These agents are used as diagnostic tool in providing symptomatic relief in infants. Associated benefits include symptomatic alleviation of constipation (aluminium antacids) or loose stools (magnesium antacids).

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Aluminum hydroxide (ALternaGEL, Amphojel)

 

Increases gastric pH above 4 and inhibits proteolytic activity of pepsin, reducing acid indigestion. Antacids can initially be used in mild cases. No effect on frequency of reflux but decreases its acidity.

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Magnesium hydroxide (Phillips Milk of Magnesia)

 

Causes osmotic retention of fluid, which distends colon and increases peristaltic activity. Forms magnesium chloride in vivo after reacting with stomach hydrochloric acid.

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H2 receptor antagonists

Class Summary

Like antacids, these agents do not reduce the frequency of reflux, but they decrease the amount of acid in the refluxate by inhibiting acid production. All are equipotent when used in equivalent doses. Work best in patients with nonerosive esophagitis. Because of proton pump inhibitor (PPI) superiority, H2 blockers are reserved for use in patients unable to tolerate PPIs.

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Ranitidine (Zantac)

 

Inhibits histamine stimulation of the H2 receptor in gastric parietal cells, which reduces gastric acid secretion, gastric volume, and hydrogen ion concentrations.

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Famotidine (Pepcid)

 

Competitively inhibits histamine at H2 receptor of gastric parietal cells, resulting in reduced gastric acid secretion, gastric volume, and hydrogen ion concentrations.

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Proton pump inhibitors

Class Summary

These agents are indicated in patients who need complete acid suppression (eg, infants with chronic respiratory disease or neurologic disabilities). Administer with the first meal of the day (children with nasogastric or gastrostomy tubes may have granules mixed with an acidic juice, then flush tubes to prevent blockage).

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Omeprazole (Prilosec)

 

Decreases gastric acid secretion by inhibiting the parietal cell H+/K+ -ATP pump. Used for the short-term treatment (4-8 wk) of GERD.

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Lansoprazole (Previcid)

 

Suppresses gastric acid secretion by specific inhibition of the (H+, K+)-ATPase enzyme system (ie, proton pump) at the secretory surface of the gastric parietal cell. It blocks the final step of acid production. The effect is dose-related and inhibits both basal and stimulated gastric acid secretion, thus increasing gastric pH.

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Esomeprazole magnesium (Nexium)

 

S-isomer of omeprazole. Inhibits gastric acid secretion by inhibiting H+/K+ -ATPase enzyme system at secretory surface of gastric parietal cells.

Used in severe cases of and patients not responding to H2 antagonist therapy.

Used for up to 4 wk to treat and relieve symptoms of active duodenal ulcers; may be used up to 8 wk to treat all grades of erosive esophagitis.

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Contributor Information and Disclosures
Author

Pegeen Eslami, MD  Assistant Professor of Pediatrics, Division of Pediatric Emergency Medicine, UMass Memorial Medical Center

Pegeen Eslami, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, American College of Emergency Physicians, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Raj D Sheth, MD  Professor, Mayo College of Medicine; Chief, Division of Pediatric Neurology, Nemours Children's Clinic

Raj D Sheth, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, American Neurological Association, and Child Neurology Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Jorge H Vargas, MD  Professor of Pediatrics and Clinical Professor of Pediatric Gastroenterology, University of California, Los Angeles, David Geffen School of Medicine; Consulting Physician, Department of Pediatrics, University of California at Los Angeles Health System

Jorge H Vargas, MD is a member of the following medical societies: American Liver Foundation, American Society for Gastrointestinal Endoscopy, American Society for Parenteral and Enteral Nutrition, Latin American Society of Pediatric Gastroenterology, Hepatology & Nutrition, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

David A Piccoli, MD  Chief of Pediatric Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia; Professor, University of Pennsylvania School of Medicine

David A Piccoli, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Steven M Schwarz, MD, FAAP, FACN, AGAF  Professor of Pediatrics, Children's Hospital at Downstate, State University of New York Downstate Medical Center

Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research

Disclosure: Curemark, LLC Consulting fee Board membership; Centocor, Inc. Grant/research funds Independent contractor; Johnson & Johnson, Inc. Grant/research funds Independent contractor

Chief Editor

Carmen Cuffari, MD  Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

References

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Diagram illustrating the Nissen fundoplication. Note how the stomach is wrapped around the esophagus (360º wrap).
 
 
 
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