Persistent hiccups (>48 hours) may result in exhaustion, discomfort, weight loss (due to interference with food intake), insomnia, and depression.ġ) CNS disorders: Vascular, inflammatory, neoplastic, multiple sclerosis, hydrocephalus.Ģ) Metabolic disorders: Diabetes mellitus, uremia, hyponatremia, hypocalcemia, hypocapnia.ģ) Toxins and drugs: Alcohol, nicotine, barbiturates, benzodiazepines, etoposide, dexamethasone.Ĥ) Neck and chest disorders: Tumor, lymphadenopathy, lung cancer, pneumonia with pleural inflammation, myocardial infarction, esophageal cancer, mediastinal tumors, diaphragmatic hernia, gastroesophageal reflux disease ( GERD).ĥ) Abdominal disorders: Gastric cancer, peptic ulcer disease, gastric distension (a very common cause), gastrointestinal ( GI) bleeding, pancreatic cancer, pancreatitis, hepatomegaly, splenomegaly, ascites, cholelithiasis, intestinal obstruction, peritonitis.Ī thorough history and physical examination often elucidate the etiology of persistent hiccups.
The vast majority of episodes of hiccups are short, self-terminating, and inconsequential, requiring no investigation. Episodes of hiccups are usually brief (lasting several minutes) and are most frequently associated with rapid or excessive gastric distension. The hiccup rate may be from 2 to 60 per minute.
Hiccups are triggered by stimulation of the vagus nerve, phrenic nerve, and sympathetic nerves innervating the chest, abdomen, ear, nose, and pharynx, or by stimulation of the hiccup center in the central nervous system ( CNS). This leads to an almost simultaneous closure of the glottis and is accompanied by a characteristic sound. Hiccups (singultus) are involuntary synchronous contractions of the intercostal muscles and the diaphragm that cause sudden inspiration.
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