Hiccups are a reflex, mostly short-lived, but always disturbing. However, there are people who have recurrent and persistent episodes of hiccups. What to do when you often hiccup and what problems it can hide, explains ENT doctor Silviu Oprescu.

The medical definition of hiccups goes something like this: repeated, uncontrolled contractions of the diaphragm, the muscular structure that separates the chest cavity from the abdomen and regulates breathing.

When the diaphragm contracts, the lungs receive oxygen. When the diaphragm relaxes, the lungs release carbon dioxide.

Why do we hiccup?

• The cause of hiccups is the contraction of the diaphragm outside the normal rhythm. Each spasm of the diaphragm leads to a sharp closing of the larynx and vocal cords. This leads to a sudden expulsion of air from the lungs. The body reacts by creating a characteristic hiccup sound.
• Most hiccups start and stop suddenly for no apparent reason. Episodes usually last only a few minutes.

“As a rule, hiccups should be short-lived and fleeting. But in some cases, they can last for hours or even days, and in these cases they can hide behind various pathologies: ENT or gastroenterological (reflux disease, cervical tumors), neurological (meningoencephalitis, brain tumors, multiple sclerosis) or psychobehavioral. (use of alcohol, drugs, tranquilizers, steroids),” explains Silviu Oprescu, chief ENT doctor at Monza Hospital.

What is a hiccup?

Neurologically, hiccups are a reflex. Usually, a reflex starts with a signal from the body to the spinal cord or brain, which triggers a second signal from the spinal cord or brain back to the body.

But in the case of hiccups, three things happen:

• 1. Stimulation of the vagus and other nerves sends messages to the spinal cord in the brain;
• 2. The spinal bulb sends a signal to the phrenic nerve, prompting the diaphragm to contract;
• 3. The voice block suddenly closes.

Short hiccup

Many causes of hiccups have been identified. However, there is no clear list of triggers. Hiccups often come and go for no apparent reason.

Common causes of hiccups include:

• overeating
• spicy food,
• alcohol,
• sodas,
• very hot or very cold food,
• sudden change in air temperature,
• aerophagia,
• chewing gum,
• strong emotions or stress.

“We must distinguish between the hiccups of babies and the hiccups of adults! If in the pediatric population, hiccups can be considered non-pathological due to the insufficient development of peripheral and central nervous structures, then in the mature population, hiccups usually mean irritation of the phrenic or vagus nerves,” emphasizes the doctor. Silviu Oprescu.

There are several factors that can predispose you to hiccups:

• male,
• greater sensitivity to anxiety,
• surgical interventions, especially in the abdomen,
• general anesthesia

What to do with hiccups

Most hiccups are not an emergency or cause for concern. However, a prolonged episode can be uncomfortable and interfere with daily activities.

It is advisable to consult a doctor if the hiccups last more than two days. Your doctor can determine the severity of hiccups based on your general health and other conditions.

Remedies for hiccups

There are many treatment options for hiccups. Hiccups usually go away on their own. However, there are also remedies that can be useful. You can try, for example, the following techniques:

• breathe into a paper bag
• eat a teaspoon of sugar
• hold your breath
• drink a glass of cold water
• pull your knees to your chest and hold this position,
• try the Valsalva maneuver – close your mouth and pinch your nose during a strong exhalation,
• relax and breathe slowly, in a controlled manner.

drugs

Treating any underlying causes will also stop the hiccups. If the hiccups last longer and have no obvious cause, your doctor may recommend other anti-hiccups. The most commonly used include:

• antipsychotic drugs,
• benzodiazepines, a class of tranquilizers,
• anticonvulsant medicines such as gabapentin,
• diphenhydramine, an antihistamine,
• metoclopramide, a medicine for nausea,
• baclofen, muscle relaxant,
• nifedipine, a blood pressure medicine.

The US Food and Drug Administration (FDA) has not approved any prescription drugs to treat hiccups.

Massage

A doctor may massage the carotid sinus to stop prolonged hiccups.

Invasive procedures

There are also more invasive options that can be used to stop extreme cases of hiccups. They include:

• nasogastric intubation, that is, the introduction of a probe through the nose into the stomach;
• gastric lavage;
• injection of anesthetic to block the phrenic nerve, which is located in the diaphragm;
• surgical implantation of a diaphragmatic pacemaker, a battery-powered device that stimulates the diaphragm and regulates breathing.

Constant hiccups, reasons

Hiccups that last more than 48 hours are considered permanent. Hiccups that last more than 2 months are considered difficult to treat.

These types of persistent hiccups are classified according to the type of stimulus that triggered the episode.

Nerve damage or irritation

Most cases of persistent hiccups are caused by damage or irritation of the vagus or phrenic nerves. The movement of the diaphragm is controlled by the vagus and phrenic nerves. These nerves can be affected by:

• irritation of the eardrum, which can be caused by a foreign object;
• throat irritation or pain;
• goiter;
• gastroesophageal reflux disease;
• cyst or tumor of the esophagus.

Other causes of hiccups may involve the central nervous system. It consists of the brain and spinal cord. If the central nervous system is damaged, the body may lose the ability to control hiccups.

Central nervous system injuries that can cause persistent hiccups include:

• stroke,
• multiple sclerosis,
• tumors,
• head injury or brain damage,
• meningitis and encephalitis – infections that can cause inflammation of the brain,
• hydrocephalus or accumulation of fluid in the brain,
• neurosyphilis and other brain infections.

Other reasons

Hiccups that last longer can also be caused by:

• alcohol abuse,
• tobacco use,
• reaction to anesthesia after surgery,
• certain classes of drugs, including barbiturates, steroids, and tranquilizers,
• electrolyte imbalance,
• diabetes,
• kidney failure,
• arteriovenous malformation,
• Parkinson’s disease,
• cancer treatment and chemotherapy.

Medical procedures

Sometimes a medical procedure can accidentally cause persistent hiccups. These procedures are used to treat or diagnose other conditions and include:

• with the help of catheters to access the heart muscle;
• placement of an esophageal stent to support the opening of the esophagus;
• bronchoscopy, a test used to examine the lungs and airways;
• tracheostomy

Diagnostic

If the cause of hiccups is unclear, your doctor may recommend certain tests, including:

• blood tests to detect signs of infection, diabetes, or kidney disease;
• liver functions;
• images of the diaphragm (chest X-ray, computer tomography or⦁ MRI);
• echocardiogram to assess heart function;
• endoscopy for examination of esophagus, trachea, stomach and intestines;
• bronchoscopy.

Possible complications of untreated hiccups

A prolonged episode of hiccups can be uncomfortable and even harmful. If left untreated, persistent hiccups can disrupt sleep and eating, leading to:

• insomnia,
• exhaustion,
• malnutrition,
• weight loss,
• dehydration

How to prevent hiccups

There are no proven methods to prevent hiccups. However, if you often experience hiccups, you can try to reduce the impact of known triggers:

• Try not to overeat.
• Avoid carbonated drinks.
• Avoid sudden changes in temperature.
• Do not drink alcoholic beverages.
• Avoid stressful situations and intense physical exertion.

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