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Hiccups

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Hiccups



Introduction
 


Hiccups



 

Hiccups occur when the diaphragm suddenly and involuntarily contracts (tightens), resulting in a hiccup sound being produced at the top of the windpipe.

The diaphragm is a thin membrane of muscle that separates the chest cavity from the abdomen (tummy). It is located underneath the ribcage and helps to control breathing.

The medical name for hiccups is "singultus".

What causes hiccups?

Hiccups are very common and most people will get them at some point during their life. They can affect people of any age, including babies.

Hiccups often occur without any obvious trigger, although short episodes have been linked with:



drinking alcohol 



smoking



having a bloated stomach



eating too quickly or eating spicy foods



drinking hot or fizzy drinks



emotions, such as stress, fear or excitement



In rare cases, hiccups can last for a long time. If hiccups last for more than 48 hours they are known as "persistent" or "protracted" hiccups, and hiccups that last longer than a month are called "intractable" hiccups.

These longer-lasting hiccups have been linked with a number of underlying medical conditions and some medications.

When to seek medical advice

Hiccups are not usually serious and in most cases only last a few minutes.

However, you should see your GP if you have hiccups that recur frequently or last longer than 48 hours so they can try to identify a possible cause and determine whether any further investigation or treatment is necessary.

How hiccups are treated

Most hiccups will pass quickly and won't need any specific treatment.

If your hiccups are troublesome, there are some things you can do that may help, such as:



sipping ice-cold water



holding your breath for a short period



biting on a lemon



swallowing granulated sugar



tasting vinegar



pulling your knees up to your chest



For longer-lasting hiccups, identifying and treating any identifiable cause may help, and there are also a number of medications that are sometimes used specifically to control hiccups.

Hiccups are not usually serious and most cases only last for a few minutes 

 

Causes of hiccups 



Hiccups occur when your diaphragm (the thin layer of muscle that separates your chest cavity from your abdomen) suddenly and involuntarily contracts (tightens).

As your diaphragm contracts, it causes you to breathe air in very quickly. The incoming air is stopped when your glottis (the opening between your vocal cords) closes suddenly, producing the characteristic sound of a hiccup.

Causes of short-term hiccups

Most cases of hiccups occur for no apparent reason. Everyone experiences a short bout of hiccups from time to time. This is perfectly normal and nothing to be concerned about.

In some cases however, short-term hiccups may appear to have a specific trigger, such as:



drinking alcohol



smoking



having a bloated stomach



eating too quickly or eating spicy foods



drinking hot or fizzy drinks



swallowing air – for example, while chewing gum



a sudden change in room temperature



a sudden change in the temperature inside your stomach – for example, eating something hot followed by a cold drink



emotions, such as stress, fear or excitement



People experiencing short-term hiccups usually pass without the need for treatment.

Causes of long-lasting hiccups

In rare cases, hiccups that last 48 hours or longer can be caused by an underlying condition or a medication you are taking, although in many cases a cause is not identified.

Underlying conditions

Some of the conditions that can cause long-term hiccups include:



gastrointestinal conditions – such as gastro-oesophageal reflux disease (GORD), inflammatory bowel disease (IBD) or a small bowel obstruction



respiratory conditions – such as asthma, pneumonia or pleurisy



conditions affecting the central nervous system – such as stroke, a tumour affecting the brain, encephalitis or a traumatic brain injury



a condition irritating the vagus nerve (a nerve that controls the diaphragm) – such as goitre, pharyngitis or meningitis



a psychological reaction – such as shock, fear, grief, excitement, or stress



conditions involving your metabolism (the way your body digests food) – such as diabetes, hypoglycaemia orhyperglycaemia



Medication

Persistent hiccups can sometimes also be caused by a reaction to certain types of medication, such as:



anaesthesia – medication given before a surgical operation or procedure that causes a loss of sensation or consciousness



corticosteroids – medication that reduces inflammation (swelling)



benzodiazepines – a type of sedative that helps to reduce anxiety



barbiturates – a type of sedative sometimes used to prevent seizures (fits)



opioids – medication used to treat pain; morphine and methadone are both strong opioids



methyldopa – medication used to treat high blood pressure(hypertension)



chemotherapy medications – medicines used to kill cancer cells



If an underlying cause of long-lasting hiccups can be identified, treating this cause can help improve the problem.

 

Diagnosing hiccups 

In most cases there is no need to see your GP if you have hiccups because they are not usually a sign of anything serious and will pass in a few minutes.

However, you should see your GP if you have hiccups that frequently come back or last longer than 48 hours. They can try to identify a possible cause and determine whether any further investigation or treatment is necessary.

Your GP may want to examine you. This might include examining your head and neck (including your mouth), your chest, and your abdomen (tummy).

Tests

If it is thought your hiccups could be related to an underlying condition, you may be referred for further tests. These may include:



blood tests to check for diabetes or kidney or liver problems



an X-ray, computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan to check for problems such as an infection or tumour



an electrocardiogram (ECG) – a test that measures electrical activity in your heart – to check for heart conditions



In some cases, an endoscopy may be recommended. This procedure examines the inside of your body using an endoscope (a long, thin, flexible tube with a light source and a video camera at one end).

An endoscope can be used to examine different areas of the body, depending on where the suspected problem lies. For example, an endoscopy may be carried out to assess your oesophagus (gullet) and stomach if your doctor thinks your hiccups may be related to gastro-oesophageal reflux disease (GORD).

Treating hiccups 

Most cases of hiccups do not require medical treatment and will usually stop after a short period of time.

However, some simple techniques may help if your hiccups are particularly troublesome, and medical treatments are available if the problem is long-lasting.

Self-help techniques

There are a number of things you can try yourself initially that may help to stop your hiccups. These include:



sipping ice-cold water



holding your breath for a short period



biting on a lemon



swallowing granulated sugar



tasting vinegar



breathing into a paper bag (never place a bag over your head)



pulling your knees up to your chest



leaning forward to compress your chest



However, while some people do find that these techniques can be helpful, they have not been tested in medical studies and it's not clear how effective they actually are.

Treating long-lasting hiccups

If an underlying health condition is causing your hiccups, treating it may help to resolve the problem.

For example, if you are diagnosed with gastro-oesophageal reflux disease (GORD), you may be prescribed a medication called a proton pump inhibitor (PPI) to reduce the amount of acid produced by your stomach.

Some conditions that cause persistent and intractable hiccups may need to be assessed and treated by a specialist. If this is the case, your GP will refer you to the appropriate healthcare professional, who will carry out further investigations and recommend appropriate treatment.

Medication for hiccups

If other treatments have failed, or no underlying cause can be found, your GP may offer you medication to specifically treat your hiccups.

A number of different medications are used to help treat hiccups, although there isn't much high-quality evidence to suggest these are consistently effective.

Some medicines that may be used include:



chlorpromazine



haloperidol



baclofen



metoclopramide



gabapentin



Your GP will usually prescribe one of these medications for several weeks, during which time they may gradually increase your dose until your hiccups are brought under control. Your dose will then be slowly reduced until you can stop taking the medication.

If your hiccups return as your dose is being reduced or after treatment stops, your GP may recommend increasing your dose again or restarting treatment.

Your GP may suggest trying an alternative medication if the first medicine you try doesn't help to resolve your hiccups.

 

All the medicines used for hiccups can cause side effects, so make sure you speak to your GP about the potential side effects you may experience before starting treatment.