Hiccups

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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 intraoperative 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; in women, psychogenic causes are more common.
  • Specific underlying causes include the following:
    • CNS disorders: vascular lesions (AV malformation), infectious causes (meningitis, encephalitis), structural lesions (intracranial/brainstem mass lesions, multiple sclerosis, hydrocephalus, syringomyelia), posterior inferior cerebellar artery (PICA) aneurysm; 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)
    • Hiccups have been reported as an initial presentation of COVID-19
    • Cardiovascular disorders (MI, pericarditis) (3)
    • 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, levofolinate, oxaliplatin, fluorouracil, carboplatin, cisplatin, tramadol) (4)
    • Toxic (alcohol-induced)
    • Psychogenic causes (anorexia, conversion, grief, malingering, schizophrenia, stress)
    • 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 (5).

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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 intraoperative 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; in women, psychogenic causes are more common.
  • Specific underlying causes include the following:
    • CNS disorders: vascular lesions (AV malformation), infectious causes (meningitis, encephalitis), structural lesions (intracranial/brainstem mass lesions, multiple sclerosis, hydrocephalus, syringomyelia), posterior inferior cerebellar artery (PICA) aneurysm; 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)
    • Hiccups have been reported as an initial presentation of COVID-19
    • Cardiovascular disorders (MI, pericarditis) (3)
    • 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, levofolinate, oxaliplatin, fluorouracil, carboplatin, cisplatin, tramadol) (4)
    • Toxic (alcohol-induced)
    • Psychogenic causes (anorexia, conversion, grief, malingering, schizophrenia, stress)
    • 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 (5).

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