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Genetic and Rare Diseases Information Center (GARD)

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Chronic hiccups


Other Names for this Disease
  • Hiccups, intractable
  • Intractable hiccups
  • Intractable singultus
  • Persistent hiccups
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Your Question

I have experienced several bouts of hiccups that go on for several weeks to months with no relief. I have had all of the normal tests to determine a cause, but no cause has been identified. I also have other stomach problems. What causes intractable hiccups? What tests may be conducted to determine the underlying cause of intractable hiccups? Can intractable hiccups be related to other stomach problems? How might intractable hiccups be treated? 

Our Answer

We have identified the following information that we hope you find helpful. If you still have questions, please contact us.

What are chronic hiccups?

Chronic hiccups are hiccups that persist for a long period of time or recur frequently over an extended period of time.[1][2] A hiccup is an unintentional movement (spasm) of the diaphragm, the muscle at the base of the lungs. The spasm is followed by the rapid closure of the vocal cords, which produces a distinctive sound.[3][1] Hiccups often start for no apparent reason and usually disappear after a few minutes.[3] Hiccups that last for more than two days and less than a month are sometimes called persistent or protracted hiccups. On rare occasions, hiccups persist even longer than a month or recur frequently over an extended period of time, and are called intractable hiccups.[1][2] Intractable hiccups are difficult to treat and often indicate the presence of another medical problem.[1][4][5]
Last updated: 6/21/2013

What causes chronic hiccups?

Hiccups occur when the diaphragm becomes irritated. Some things that irritate the diaphragm are eating too quickly or too much, an irritation in the stomach or the throat, or feeling nervous or excited.[5] In many cases, there is no obvious cause (idiopathic).[3][2]

Some additional causes include:[3][2]
  • Abdominal surgery
  • Any disease or disorder that irritates the nerves that control the diaphragm (such as pleurisy or pneumonia)
  • Hot and spicy foods or liquids
  • Noxious fumes
  • Stroke or tumor affecting the 'hiccup center' in the brain
  • Use of alcohol and/or tobacco in excess

There are many known causes of chronic hiccups, among which the most prominent is esophagitis due to gastroesophageal reflux (GERD).[4][6] Other cases occur in association with central nervous system problems or result from serious pathophysiological processes affecting a component of the hiccup reflex mechanism.[4][2][6] A full systemic inquiry, surgical history, and comprehensive drug history may reveal one of the many causes.[2]

You can click on the links below to access comprehensive listings of the causes of chronic hiccups.
http://emedicine.medscape.com/article/775746-overview#ClinicalCauses
http://www.merck.com/mmpe/sec02/ch007/ch007d.html#BABDJBBJ
Last updated: 2/20/2012

What tests can be done to determine the cause of chronic hiccups?

The diagnosis of chronic hiccups involves the exclusion of several neurological, gastrointestinal, thoracic, and metabolic disorders.[7] Careful examination should be made of the head, mouth, neck, chest, cardiovascular system, abdomen, rectum, and neurological system.[2]

Medscape Reference provides a listing of the tests that may be done in the process of diagnosing chronic hiccups.
Last updated: 2/20/2012

Can chronic hiccups be associated with other problems involving the stomach?

Yes. Chronic hiccups are often associated with disorders of the gastrointestinal system, including those involving the stomach, esophagus and bowel.[1]
Last updated: 2/20/2012

How might chronic hiccups be treated?

The treatment of chronic hiccups depends on the cause. Hiccups associated with gastroesophageal reflux may be treated with antacids and omeprazole. Those found in association with central nervous system problems may be treated with Baclofen.[4] Other medications which may be used include chlorpromazine, gabapentin, valproate, and lidocaine bolus.[7] Very rarely, medical methods fail to treat persistent hiccups. Further treatment may include a phrenic nerve block. The phrenic nerve controls the diaphragm.[3]
Last updated: 2/20/2012

What types of doctors may be able to assist in determining the underlying cause and/or treatment of chronic hiccups?

Ideally patients should be managed by multidisciplinary teams with experience in complex disorders caused by thoracic and neurological pathologies.[4] Gastroenterologists and neurologists are the most common specialists on the team.[8][9]
Last updated: 2/20/2012

References