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Hiccups

Hiccups is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Hiccups are caused by a repetitive sudden involuntary contraction of the inspiratory muscles (predominantly the diaphragm) and terminated by the abrupt closure of the glottis, which stops the inflow of air and produces a characteristic sound.
  • Hiccups are classified based on their duration: Hiccup bouts last up to 48 hours; persistent hiccups last >48 hours but <1 month; intractable hiccups last for >1 month.
  • System(s) affected: nervous, pulmonary
  • Synonym(s): hiccoughs; singultus

Geriatric Considerations
Can be a serious problem, particularly among the elderly

Pregnancy Considerations
  • Fetal hiccups are rhythmic fetal movements (confirmed sonographically) that can be confused with contractions.
  • Fetal hiccups are a sign of normal neurologic development (1).

Epidemiology

  • Predominant age: all ages (including fetus)
  • Predominant sex: male > female (4:1)

Prevalence
Self-limited hiccups are extremely common, as are intra- and postoperative hiccups.

Etiology and Pathophysiology

  • Results from stimulation of ≥1 limbs of the hiccup reflux arc (vagus and phrenic nerves) with a “hiccup center” located in the upper spinal cord and brain (2)
  • In men, >90% have an organic basis; whereas in women, a psychogenic cause is more common.
  • Specific underlying causes include:
    • CNS disorders: vascular lesions (AV malformation), infectious causes (meningitis, encephalitis), structural lesions (intracranial /brainstem mass lesions, multiple sclerosis, hydrocephalus, syringomyelia)
    • Seizure disorder
    • Diaphragmatic irritation (tumors, pericarditis, eventration, splenomegaly, hepatomegaly, peritonitis)
    • Irritation of the tympanic membrane
    • Nerve irritation: pharyngitis, laryngitis, neck tumors
    • Mediastinal and other thoracic lesions (pneumonia, aortic aneurysm, tuberculosis [TB], myocardial infarction [MI], lung cancer, rib exostoses)
    • Esophageal lesions (reflux esophagitis, achalasia, Candida esophagitis, carcinoma, obstruction)
    • Gastrointestinal disorders (gastritis, GERD, PUD, distention, cancer)
    • Hepatic lesions (hepatitis, hepatoma)
    • Pancreatic lesions (pancreatitis, pseudocysts, cancer)
    • Inflammatory bowel disease
    • Cholelithiasis, cholecystitis
    • Prostatic disorders
    • Appendicitis
    • Postoperative, particularly with abdominal procedures
    • Metabolic causes (uremia, hyponatremia, gout, diabetes)
    • Drug-induced (dexamethasone, methylprednisolone, anabolic steroids, benzodiazepines, α-methyldopa, propofol)
    • Psychogenic causes (hysterical neurosis, grief, malingering)
    • Idiopathic

Risk Factors

  • Overeating
  • Consuming carbonated beverages
  • Excessive alcohol consumption
  • Excitement or emotional stress
  • Changes in ambient or gastrointestinal temperature

General Prevention

  • Identify and correct relevant underlying cause(s).
  • Avoid gastric distention.
  • Acupuncture shows promise compared to chronic drug therapy for controlling hiccups (3).

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Citation

Stephens, Mark B., et al., editors. "Hiccups." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116277/all/Hiccups.
Hiccups. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116277/all/Hiccups. Accessed April 19, 2019.
Hiccups. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116277/all/Hiccups
Hiccups [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 19]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116277/all/Hiccups.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hiccups ID - 116277 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116277/all/Hiccups PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -