Stimulus and site specific induction of hiccups in the oesophagus of normal subjects

Abstract

Background-Hiccups that are induced by a large meal have been suggested to result from gastric overdistension. The role of the oesophagus in precipitating hiccups has never been defined. Aims-To determine the involvement of oesophageal mechanoreceptors in the hiccup reflex. Methods-Ten normal healthy subjects were prospectively evaluated at a university aYliated hospital. Controlled inflation of a polyethylene bag in the proximal and distal oesophagus was carried out using slow ramp and rapid phasic distensions, by an electronic distension device. Results-Hiccups were induced in four subjects only during rapid phasic distensions and only in the proximal oesophagus. The mean (SEM) minimal volume threshold for the hiccup reflex was 32.5 (4.8) ml, which was above the perception threshold. Hiccups appeared during inflation and resolved after deflation. Conclusions-Sudden rapid stretch of the mechanoreceptors in the proximal oesophagus can trigger the hiccup reflex in normal subjects. Only rapid distensions above a determined volume threshold will predictably induce hiccups in a given subject. This mechanism may play a role in the physiological induction of hiccups. (Gut 1997; 41: 590-593)

Giant PICA aneurysm presenting as intractable hiccups

“…1 Hiccups persisting for more than 24 hours are defined as intractable hiccups (IH) and have been associated with various systemic illnesses such as myasthenia gravis, gastrointestinal reflux disease and side effects of various medications, but rarely with conditions amenable to neurosurgical treatment. [2][3][4][5] We report a 23-year-old woman with a giant posterior inferior cerebellar artery (PICA) aneurysm compressing the medulla oblongata, who presented with intractable hiccups.…”

Postoperative Hiccup Induced by LMA—A Case Report with Literature Review

“…The stimulus for hiccups in these intraoperative settings has been attributed to LMA cuff inflation, pain at the surgical site and decreased depth of anaesthesia. The mechanism by which LMA insertion and cuff inflation triggers hiccups is considered to be due to stretching of pharyngeal mechanoreceptors, as demonstrated in cats [13] or upper oesophageal receptors, as demonstrated in humans [14]. Hiccups in this case occurred in the postoperative period just after removal of the LMA.…”

The need to move the take‐off point of the pilot tube

“…There is a similar cut in the intracuff portion of the tube to join the intramural lumen to the cuff. These cuts have been reported to render the tracheal tube weak at these points and prone to kinking [2,3]. It may be argued that the take-off point is strategically placed to indicate the depth to which the tracheal tube needs to be inserted for correct placement in the trachea.…”