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Hiccups
Last reviewed: 23.04.2024
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Hiccup (singultus) is a repeated unintentional contraction of the diaphragm, accompanied by a sudden closure of the glottis, which leads to a delay in inspiration and causes a characteristic sound. Fast-passing episodes are common. Constant (> 2 days) and severe (> 1 month) bouts of hiccups are rare and very worrisome to the patient.
[Causes of hiccoughs
Hiccups occur as a result of irritation of the centripetal or efferent diaphragmatic nerves or medullary centers controlling the respiratory muscles, especially the diaphragm. Hiccups are more common in men.
The causes of hiccups are generally unknown, but transient hiccups are often caused by stretching the stomach, drinking alcohol or swallowing hot or irritating substances. Constant and severe hiccups are polyethiologic, including the most frequently gastroesophageal reflux disease (GERD) and other diseases of the esophagus. Additional abdominal causes are intestinal diseases, pancreatitis, pregnancy, gall bladder disease, liver metastases, hepatitis and abdominal operations. The causes can be diseases and injuries of the chest and mediastinal organs, pleurisy, pneumonia, pericarditis or surgical interventions on the diaphragm. Metabolic disorders include uremia and alcoholism. Tumors of the posterior fossa or strokes can cause hiccups, stimulating the centers in the medullary reticular formation.
Evaluation and treatment of hiccups
In acute episodes of hiccups, no special evaluation is required if a normal medical history and physical examination does not reveal any abnormalities; identified violations require an appropriate survey. Prolonged hiccups and absence of a visible cause require a check including the determination of serum electrolytes, blood urea nitrogen and creatinine, chest X-ray and electrocardiography. It is necessary to perform endoscopy of the upper gastrointestinal tract and, if possible, to monitor the pH of the esophagus. If no abnormalities are detected, brain MRI and CT of the thoracic cavity can be performed. The detected disorders require treatment (eg, proton pump inhibitors in GERD, dilatation of esophageal stricture).
Symptomatic treatment of hiccups
Treatment of hiccups involves the use of many simple measures, but none of them is sufficiently effective: increasing the partial pressure of CO 2 inhibits the contractile activity of the diaphragm, which is achieved by a series of deep breathing delays or deep breathing into a paper bag.
WARNING. Polyethylene bags can block the nostrils and should not be used.
It may be effective to stimulate the vagus nerve with swallowing movements (eg swallowing dry bread, sugar or chipped ice, traction for the tongue, stimulation of vomiting movements). There are numerous other alternative means.
Constant hiccoughs are often resistant to treatment. Many different medications have been recommended. Baclofen may be effective as an agonist of y-aminobutyric acid, 5 mg orally every 6 hours, with an increase in the dose of up to 20 mg per reception. Other drugs include chlorpromazine 25-50 mg intravenously every 6 hours, metoclopramide 10 mg orally 4 times a day and various antispastic drugs. In addition, proton pump inhibitors can be used empirically. In severe cases, blockade of the diaphragmatic nerve can be used in small doses of 0.5% of the procaine solution, preserving caution to avoid respiratory failure and pneumothorax. Even bilateral frenicotomy is not always effective.