Protracted Hiccups due to Severe Erosive Esophagitis

Pooran, Nakechand; Lee, David; Sideridis, Kostas

doi:10.1097/00004836-200603000-00002

Cited by 24 publications

(17 citation statements)

References 10 publications

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“…In addition, etiologies of underlying disorders should be evaluated and corresponding treatment should follow [3]. Non-pharmacological therapy is method to inhibit afferent pathway of vagus nerve, for example, holding a breath, drinking cold water, and inserting a nasogastric tube.…”

Section: Discussionmentioning

confidence: 99%

“…If they last longer than 1 month, the condition is classified as "intractable hiccups" [2]. Both pharmacological and non-pharmacological treatment can be used to cure the disease, and if these two methods are ineffective, a nerve block can be considered [3]. We, as the authors in this study, applied a phrenic nerve block after the patient did not respond well to a pharmacological treatment.…”

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confidence: 99%

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Ultrasound-guided Pulsed Radiofrequency Lesioning of the Phrenic Nerve in a Patient with Intractable Hiccup

et al. 2010

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Persistent and intractable hiccups (with respective durations of more than 48 hours and 1 month) can result in depression, fatigue, impaired sleep, dehydration, weight loss, malnutrition, and aspiration syndromes. The conventional treatments for hiccups are either non-pharmacological, pharmacological or a nerve block treatment. Pulsed radiofrequency lesioning (PRFL) has been proposed for the modulation of the excited nervous system pathway of pain as a safe and nondestructive treatment method. As placement of the electrode in close proximity to the targeted nerve is very important for the success of PRFL, ultrasound appears to be well suited for this technique. A 74-year-old man suffering from intractable hiccups that had developed after a coronary artery bypass graft and had continued for 7 years was referred to our pain clinic. He had not been treated with conventional methods or medications. We performed PRFL of the phrenic nerve guided by ultrasound and the hiccups disappeared.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Ultrasound-guided Pulsed Radiofrequency Lesioning of the Phrenic Nerve in a Patient with Intractable Hiccup

et al. 2010

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“…Even it may be underestimated among the GERD patients, a case series indicated that 7.9% male and 10% female ( P < 0.05) GERD patients had hiccup episodes 32. In addition, acid infusion as a provocative test did confirm the GERD related hiccup, while some prolonged hiccups also responded well to the proton pump inhibitors 33,34. Since severe belching may sometime precede the hiccup episode, perhaps belching is the mechanism leading to hiccup among the GERD subjects 35.…”

Section: Etiology Of Persistent and Intractable Hiccupsmentioning

confidence: 99%

Hiccup: Mystery, Nature and Treatment

Chang¹,

2012

J Neurogastroenterol Motil

167

173

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Hiccup is the sudden onset of erratic diaphragmatic and intercostal muscle contraction and immediately followed by laryngeal closure. The abrupt air rush into lungs elicits a "hic" sound. Hiccup is usually a self-limited disorder; however, when it is prolonged beyond 48 hours, it is considered persistent whereas episodes longer than 2 months are called intractable. A reflex arc involving peripheral phrenic, vagal and sympathetic pathways and central midbrain modulation is likely responsible for hiccup. Accordingly, any irritant in terms of physical/chemical factors, inflammation, neoplasia invading the arc leads to hiccups. The central causes of hiccup include stroke, space occupying lesions and injury etc, whereas peripheral causes include lesions along the arc such as tumors, myocardial ischemia, herpes infection, gastroesophageal reflux disease and applied instrumentations on human body etc. Besides, various drugs (eg, anti-parkinsonism drugs, anesthetic agents, steroids and chemotherapies etc) are the possible etiology. An effective treatment of persistent hiccup may be established upon the correct diagnosis of lesion responsible for the serious event. The pharmacotherapy of hiccup includes chlorpromazine, gabapentin, baclofen, serotonergic agonists, prokinetics and lidocaine. Non-pharmacological approaches such as nerve blockade, pacing, acupuncture and measures to hold breathing are also successful. Finally, alternative medicines and remedies are convenient to treat hiccups with uncertain effect. In conclusions, hiccup is likely to result from lesions involving the hiccup reflex arc. The lesion may need to be localized correctly for ablative treatment in patients with intractable hiccup. Apart from lesion ablation, drugs acting on reflex arc may be effective, while some other conventional measures may also be tried.

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“…It has also been postulated that hiccups can worsen GERD by increasing gastric pressure secondary to diaphragmatic contractions or by negative esophageal pressure with decreased lower esophageal sphincter (LES) tone during the hiccups. 4 The most likely cause of persistent hiccups in our patient is erosive esophagitis. Persistent hiccups have also been reported as the initial presentation of esophageal carcinoma making EGD evaluation and esophageal biopsy critical in these patients.…”

Section: Discussionmentioning

confidence: 65%

A Case of Obstructive Sleep Apnea, Gastroesophageal Reflux Disease, and Chronic Hiccups: Will CPAP Help?

DelRosso

Hoque²

2013

Journal of Clinical Sleep Medicine

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A 60-year-old African American man with past medical history of coronary artery disease, diabetes mellitus, gastroesophageal refl ux disease (GERD), hypertension, and asthma presented for evaluation of possible sleep disordered breathing. During the visit, frequent hiccups were noted. The hiccups started one year ago, were temporarily relieved with omeprazole 20 mg once a day, and became intractable in the last month. He denied nausea, vomiting, diarrhea, or weight loss.Daily medications included amlodipine 10 mg, clopidogrel 75 mg, doxazosin 4 mg, lisinopril 10 mg, furosemide 20 mg, omeprazole 20 mg, pravastatin 40 mg, ranitidine 150 mg, glipizide 10 mg, metoprolol 25 mg, and albuterol metered dose inhaler. He smoked a half-pack of cigarettes per day for 40 years. He denied alcohol or drug use. Family history included hypertension, diabetes, and stroke.Physical exam revealed an obese male (body mass index 37) with hiccups approximately every 3 seconds. Mild inferior nasal turbinate hypertrophy was noted bilaterally. Oral airway evaluation showed an enlarged tongue with a Mallampati score of 4. The remainder of his physical examination and neurological examination was normal.Chest x-ray and non-contrast head computerized tomography (CT) were unremarkable. Magnetic resonance imaging of the brain with and without gadolinium contrast showed mild subcortical white matter ischemic changes. A non-contrast CT of the chest showed diffuse esophageal thickening, and esophagogastroduodenoscopy (EGD) revealed severe chronic esophagitis with a 5-cm ulcer.A split-night polysomnogram showed evidence of severe obstructive sleep apnea (OSA). The apnea index was 107 events per hour. Hypopneas were not seen during the diagnostic portion of the study. A representative 60-sec epoch is shown in Figure 1. Continuous positive airway pressure (CPAP) titration with a full-face mask showed resolution of sleep disordered breathing at a pressure of 18 cm of water. QUEStIONWhat is the cause of the event depicted by the red arrow in this 60-sec epoch (Figure 1)?

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Protracted Hiccups due to Severe Erosive Esophagitis

Abstract: Hiccups are an atypical manifestation and may represent a more severe course of gastroesophageal reflux disease.

Cited by 24 publications

References 10 publications

Ultrasound-guided Pulsed Radiofrequency Lesioning of the Phrenic Nerve in a Patient with Intractable Hiccup

Ultrasound-guided Pulsed Radiofrequency Lesioning of the Phrenic Nerve in a Patient with Intractable Hiccup

Hiccup: Mystery, Nature and Treatment

A Case of Obstructive Sleep Apnea, Gastroesophageal Reflux Disease, and Chronic Hiccups: Will CPAP Help?

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