Hiccup in adults: an overview

Abstract

Hiccup is a forceful, involuntary inspiration commonly experienced by fetuses, children and adults. Its purpose is unknown and its pathophysiology still poorly understood. Short hiccup bouts are mostly associated with gastric distention or alcohol intake, resolve spontaneously or with simple folk remedies and do not require medical attention. In contrast, prolonged hiccup is a rare but disabling condition which can induce depression, weight loss and sleep deprivation. A wide variety of pathological conditions can cause chronic hiccup: myocardial infarction, brain tumour, renal failure, prostate cancer, abdominal surgery etc. Detailed medical history and physical examinations will often guide diagnostic investigations (abdominal ultrasound, chest or brain CT scan...). Gastric and duodenal ulcers, gastritis, oesophageal reflux and oesophagitis are commonly observed in chronic hiccup patients and upper gastrointestinal investigations (endoscopy, pH monitoring and manometry) should be included in the diagnostic evaluation systematically. Etiological treatment is not always available and chronic hiccup treatment has classically relied on metoclopramide and chlorpromazine. Recently, baclofen (LIORESAL) has emerged as a safe and often effective treatment.

Regional Anesthesia to the Rescue: Phrenic Nerve Block to Prevent Wound Dehiscence From Intractable Hiccups—A Case Report

“…Imaging studies have demonstrated that contraction of the diaphragm during a hiccup is usually unilateral, with the left side more often involved than the right side and synchronized with interscalene and intercostal muscle activity. 5 Although most hiccups are short-lived, chronic hiccups can result from a range of causes including lung malignancies, pancreatitis, mass effects on the posterior cervical region, multiple sclerosis, brainstem tumors, central lesions, hiatal hernias, gastric distention, hepatomegaly, abdominal tumors, and a variety of surgical procedures, including Nissen fundoplication. 1,4,6…”

“…Medical management includes trials of baclofen, chlorpromazine, gabapentin, haloperidol, metoclopramide, midazolam, olanzapine, and promethazine. 1,5 Physiological maneuvers incorporate vagal maneuvers, carotid sinus pressure, breath-holding, and induction of emesis. More invasive methods that have been reported include phrenic nerve blocks, vagal simulators, phrenicectomies, transesophageal diaphragmatic pacing, cervical epidural injections, and phrenic nerve crushing.…”

“…1,5–8 A variety of other controversial modalities have been attempted, including acupuncture, inhalation of mild irritants, fasting, changing patient positioning, and heat/cold applications, all with varying degrees of effectiveness. 5…”

Contemporary view of arishta lakshanas: prognosis based on ominous signs

“…Persistent hiccup in debilitated individuals, particularly after acute myocardial infarction, might stymie healing and potentially put the patient's life in jeopardy, necessitating drastic therapeutic treatments. 37 Ischemia or myocardial infarction can be the primary cause and a key risk factor for cardiovascular hiccups. The most common cause of hiccups is inferior myocardial infarction in patients undergoing stroke rehabilitation or palliative care setting.…”

Cervical repetitive peripheral magnetic stimulation relieves idiopathic persistent hiccups: A preliminary study of case report

“…Hiccups are caused by a series of involuntary spasmodic contractions of the diaphragm and intercostal muscles, followed by a sudden closure of the glottis, which results in a peculiar “hic” sound. [1,2] It is widely believed that hiccups are caused by a “reflex arc,” which includes an afferent limb, a central connection, an efferent limb, and effectors. [3,4] Typically, hiccups occur in cycles of 4 to 60 per minute and could be considered a form of diaphragmatic rhythmic myoclonus.…”