- 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
Can be a serious problem, particularly among the elderly
- Fetal hiccups are rhythmic fetal movements (confirmed sonographically) that can be confused with contractions.
- Fetal hiccups are a sign of normal neurologic development (1).
- Predominant age: all ages (including fetus)
- Predominant sex: male > female (4:1)
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)
- Consuming carbonated beverages
- Excessive alcohol consumption
- Excitement or emotional stress
- Changes in ambient or gastrointestinal temperature
- 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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