eMedicine Specialties > Emergency Medicine > Gastrointestinal

Hiccups: Follow-up

Author: Garry Wilkes, MBBS, FACEM, Director of Emergency Medicine, Bunbury Hospital, Western Australia; Medical Director, St John Ambulance, WA Ambulance Service; Adjunct Associate Professor, Edith Cowan University; Clinical Associate Professor, Rural Clinical School, University of Western Australia, Australia.
Contributor Information and Disclosures

Updated: Sep 29, 2009

Follow-up

Complications

  • Arrhythmias
  • Gastroesophageal reflux
  • In prolonged cases, weight loss and sleep disturbance may be noted.

Prognosis

  • Hiccups generally are self-limited, and the prognosis is excellent. The prognosis of protracted hiccups is related to that of the underlying etiology.

Miscellaneous

Medicolegal Pitfalls

  • Protracted hiccups often are associated with underlying organic disease and often induce social and emotional distress.
  • Therapy must address causative and complicating factors of protracted hiccups.

Special Concerns

  • Gastroesophageal reflux is associated closely with hiccups but may be either cause or effect. Perform acid perfusion studies confirming the inducibility of hiccups before proceeding with antireflux surgery to cure hiccups.
  • The final and most drastic treatment is phrenic nerve ablation. Fluoroscopic examination may reveal unilateral involvement allowing directed therapy. Temporary blockade is advisable initially. Bilateral phrenic nerve interruption may lead to significant respiratory complications and may not always cure hiccups, as other respiratory muscles are involved. Explore all other treatments prior to this step.
  • Patients rarely present to the ED after cessation of a brief episode of hiccups. If this occurs, first consider another reason (eg, depression) for the presentation.
 
Acknowledgments

Brief episodes of hiccups are typically of little impact and often merely a source of amusement. In contrast, persistent and intractable can be of enormous impact, impairing all aspects of daily life. My thanks to those who have shared their stories including success or otherwise.



More on Hiccups

Overview: Hiccups
Differential Diagnoses & Workup: Hiccups
Treatment & Medication: Hiccups
Follow-up: Hiccups
References
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References

  1. Vanamoorthy P, Kar P, Prabhakar H. Intractable hiccups as a presenting symptom of Chiari I malformation. Acta Neurochir (Wien). Nov 2008;150(11):1207-8; discussion 1208. [Medline].

  2. Morinaka S. Herpes zoster laryngitis with intractable hiccups. Auris Nasus Larynx. Mar 3 2009;[Medline].

  3. Salanitri S, Goncalves AJ, Helene A Jr, Lopes FH. Surgical complications in hair transplantation: a series of 533 procedures. Aesthet Surg J. Jan-Feb 2009;29(1):72-6. [Medline].

  4. Doshi H, Vaidyalingam R, Buchan K. Atrial pacing wires: an uncommon cause of postoperative hiccups. Br J Hosp Med (Lond). Sep 2008;69(9):534. [Medline].

  5. Chang CC, Chang ST, Lin JC, Li TY, Chiang SL, Tsai KC. Resolution of intractable hiccups after near-infrared irradiation of relevant acupoints. Am J Med Sci. Aug 2006;332(2):93-6. [Medline].

  6. Chang CC, Chang YC, Chang ST, Chang WK, Chang HY, Chen LC, et al. Efficacy of near-infrared irradiation on intractable hiccup in custom-set acupoints: evidence-based analysis of treatment outcome and associated factors. Scand J Gastroenterol. 2008;43(5):538-44. [Medline].

  7. Dietzel J, Grundling M, Pavlovic D, Usichenko TI. Acupuncture for persistent postoperative hiccup. Anaesthesia. Sep 2008;63(9):1021-2. [Medline].

  8. Farin A, Chakrabarti I, Giannotta SL, Vaynman S, Samudrala S. Microvascular decompression for intractable singultus: technical case report. Neurosurgery. May 2008;62(5):E1180-1; discussion E1181. [Medline].

  9. Johnson DL. Intractable hiccups: treatment by microvascular decompression of the vagus nerve. Case Report. J Neurosurg. May 1993;78(5):813-6. [Medline].

  10. Moretti R, Torre P, Antonello RM, Ukmar M, Cazzato G, Bava A. Gabapentin as a drug therapy of intractable hiccup because of vascular lesion: a three-year follow up. Neurologist. Mar 2004;10(2):102-6. [Medline].

  11. Ong AM, Tan CS, Foo MW, Kee TY. Gabapentin for intractable hiccups in a patient undergoing peritoneal dialysis. Perit Dial Int. Nov-Dec 2008;28(6):667-8. [Medline].

  12. Turkyilmaz A, Eroglu A. Use of baclofen in the treatment of esophageal stent-related hiccups. Ann Thorac Surg. Jan 2008;85(1):328-30. [Medline].

  13. Andres DW. Transesophageal diaphragmatic pacing for treatment of persistent hiccups. Anesthesiology. Feb 2005;102(2):483. [Medline].

  14. Anthoney TR, Anthoney SL, Anthoney DJ. On temporal structure of human hiccups: ethology and chronobiology. Int J Chronobiol. 1978;5(3):477-92. [Medline].

  15. Bobele M. Nonmedical management of intractible hiccups: a brief review of the literature. Psychol Rep. Aug 1987;61(1):225-6. [Medline].

  16. Brostoff JM, Birns J, Benjamin E. The "cotton bud technique" as a cure for hiccups. Eur Arch Otorhinolaryngol. May 2009;266(5):775-6. [Medline].

  17. Dunst MN, Margolin K, Horak D. Lidocaine for severe hiccups. N Engl J Med. Sep 16 1993;329(12):890-1. [Medline].

  18. Guelaud C, Similowski T, Bizec JL, Cabane J, Whitelaw WA, Derenne JP. Baclofen therapy for chronic hiccup. Eur Respir J. Feb 1995;8(2):235-7. [Medline].

  19. Howard RS, Charmers RM. Causes and treatment of persistent hiccups. Natl Med J India. May-Jun 1996;9(3):104-6. [Medline].

  20. Kolodzik PW, Eilers MA. Hiccups (singultus): review and approach to management. Ann Emerg Med. May 1991;20(5):565-73. [Medline].

  21. Kou S. An analysis on the therapeutic effects of auriculo-acupuncture in 38 obstinate hiccup cases of different races. J Tradit Chin Med. Mar 2005;25(1):7-9. [Medline].

  22. Krahn A, Penner SB. Use of baclofen for intractable hiccups in uremia. Am J Med. Apr 1994;96(4):391. [Medline].

  23. Lewis JH. Hiccups: causes and cures. J Clin Gastroenterol. Dec 1985;7(6):539-52. [Medline].

  24. Malhotra S, Schwartz MJ. Atrioventricular asystole as a manifestation of hiccups. J Electrocardiol. Jan 1995;28(1):59-61. [Medline].

  25. Marshall JB, Landreneau RJ, Beyer KL. Hiccups: esophageal manometric features and relationship to gastroesophageal reflux. Am J Gastroenterol. Sep 1990;85(9):1172-5. [Medline].

  26. Marsot-Dupuch K, Bousson V, Cabane J, Tubiana JM. Intractable hiccups: the role of cerebral MR in cases without systemic cause. AJNR Am J Neuroradiol. Nov-Dec 1995;16(10):2093-100. [Medline].

  27. Payne BR, Tiel RL, Payne MS, Fisch B. Vagus nerve stimulation for chronic intractable hiccups. Case report. J Neurosurg. May 2005;102(5):935-7. [Medline].

  28. Rousseau P. Hiccups. South Med J. Feb 1995;88(2):175-81. [Medline].

  29. Tegeder I, Meier S, Burian M, Schmidt H, Geisslinger G, Lotsch J. Peripheral opioid analgesia in experimental human pain models. Brain. May 2003;126:1092-102. [Medline].

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Further Reading

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Keywords

hiccups, hiccoughs, singultus, gastric distention, alcohol, tobacco, excitement, stress, phrenic nerve irritation

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Contributor Information and Disclosures

Author

Garry Wilkes, MBBS, FACEM, Director of Emergency Medicine, Bunbury Hospital, Western Australia; Medical Director, St John Ambulance, WA Ambulance Service; Adjunct Associate Professor, Edith Cowan University; Clinical Associate Professor, Rural Clinical School, University of Western Australia, Australia.
Disclosure: Nothing to disclose.

Medical Editor

Robin R Hemphill, MD, MPH, Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University
Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eugene Hardin, MD, FAAEM, FACEP, Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM, Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center
Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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