Hiccups – Diagnosis and treatment

Diagnosis

During the physical exam, your doctor may perform a neurological exam to check your:

• Balance and coordination
• Muscle strength and tone
• Reflexes
• Sight and sense of touch

If your doctor suspects an underlying medical condition may be causing your hiccups, he or she may recommend one or more of the following tests.

Laboratory tests

Samples of your blood may be checked for signs of:

• Diabetes
• Infection
• Kidney disease

Imaging tests

These types of tests may be able to detect anatomical abnormalities that may be affecting the vagus nerve, phrenic nerve or diaphragm. Imaging tests may include:

• Chest X-ray
• Computerized tomography (CT)
• Magnetic resonance imaging (MRI)

Endoscopic tests

These procedures utilize a thin, flexible tube containing a tiny camera, which is passed down your throat to check for problems in your esophagus or windpipe.

Treatment

Most cases of hiccups go away on their own without medical treatment. If an underlying medical condition is causing your hiccups, treatment of that illness may eliminate the hiccups. The following treatments may be considered for hiccups that have lasted longer than two days.

Medications

Drugs that may be used to treat long-term hiccups include:

• Baclofen
• Chlorpromazine
• Metoclopramide

Surgical and other procedures

If less invasive treatments aren’t effective, your doctor may recommend an injection of an anesthetic to block your phrenic nerve to stop hiccups.

Another option is to surgically implant a battery-operated device to deliver mild electrical stimulation to your vagus nerve. This procedure is most commonly used to treat epilepsy, but it has also helped control persistent hiccups.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

Although there’s no certain way to stop hiccups, if you have a bout of hiccups that lasts longer than a few minutes, the following home remedies may provide relief, although they are unproven:

• Breathe into a paper bag
• Gargle with ice water
• Hold your breath
• Sip cold water

If you have chronic hiccups, lifestyle changes may help:

• Avoid carbonated beverages and gas-producing foods
• Eat smaller meals

Alternative medicine

When long-term hiccups don’t respond to other remedies, alternative treatments, such as hypnosis and acupuncture, may be helpful.

Preparing for your appointment

While you may initially consult your family doctor about your persistent hiccups, he or she may refer you to a specialist if you have persistent or severe hiccups.

What you can do

You may want to write a list that includes:

• Detailed descriptions of your symptoms
• Information about medical problems you’ve had
• Information about the medical problems of your parents or siblings
• All the medications and dietary supplements you take
• Questions you want to ask the doctor

What to expect from your doctor

Your doctor may ask:

• When did your hiccups start?
• How often do they occur?
• Is there anything that worsens or alleviates them?
• What medications are you taking?
• Have you had a sore throat or earache?
• Do you have indigestion symptoms or bloating?
• Have you had a sore throat or changes in your voice?
• Have you had chest pain, a cough or difficulty breathing?
• Do you have headaches or other neurological symptoms?

Hiccups: Causes & Treatment

Overview

What are hiccups?

Hiccups are repeated spasms of your diaphragm paired with a ‘hic’ sound from your vocal cords closing. Your diaphragm is a muscle under your ribcage, separating your chest and stomach area. This muscle is an important part of the breathing process. It moves downward when you breathe in and upward when you breathe out.

Two things happen when you hiccup:

• Your diaphragm pulls down between breaths, making you suck in air.
• The glottis (space between the vocal cords) closes to stop more air coming in.

These actions make the ‘hic’ sound of the hiccup. The process of the hiccup happens very quickly and you’ll usually return to normal within minutes to a couple of hours without treatment.

Can hiccups happen to anyone?

Yes. Hiccups can happen to adults, children and babies.

Who commonly gets hiccups?

Hiccups are more common in men. They can also have hiccups for a longer period.

Symptoms and Causes

What causes hiccups?

It’s not clear why people get hiccups. There are several reasons hiccups might happen, including low levels of carbon dioxide in the blood and irritated nerves. The phrenic nerve (which connects the neck to the diaphragm) and vagus nerve (which connects the brain to the stomach) are important parts of the breathing process.

Mild hiccups (those that go away in a short time) can happen when you:

• Eat and drink too quickly.
• Drink carbonated beverages or alcohol.
• Eat too much.
• Experience stress – including fear and excitement.
• Over-stretch your neck.
• Take drugs (particularly those for anxiety – benzodiazepines).
• Drink a very hot or very cold drink.
• Go through chemotherapy.
• Are anesthetized for a procedure.
• Inhale toxic fumes.

What does it mean if the hiccups last for more than two days?

If your hiccups don’t go away within a few days, they are called ‘persistent.’ If they last for a few months they are called ‘intractable’ (long-lasting hiccups). Long-lasting hiccups are rare. They can be stressful and exhausting. Intractable hiccups can be part of a larger, underlying medical problem and might not go away until that issue is corrected.

Some of these larger, underlying conditions include:

• Cancer and tumors.
• Stroke.
• Disorders of the stomach or esophagus, including GERD (a gastrointestinal and abdominal disorder).
• Pleurisy of the diaphragm.
• Uremia.
• Pneumonia.
• Bowel diseases.
• Pancreatitis and bladder irritation.
• Hepatitis and liver cancer.
• Tumors and lesions.

Hiccups can also happen after surgery and during the recovery process from a procedure. See a healthcare provider if your hiccups last for a long period of time.

Diagnosis and Tests

How are hiccups diagnosed?

Diagnosing hiccups is not complicated. Your healthcare provider needs only to listen to the ‘hic’ sound.

However, your healthcare provider may perform a physical examination to see if an underlying condition may be causing your hiccups. If the physical examination reveals anything of concern, he or she may order tests such as imaging tests, endoscopic tests and lab tests.

What questions might my healthcare provider ask?

• How long have you had hiccups?
• How often do you hiccup?
• Have you tried any home remedies to fix your hiccups?
• Are you interested in taking medication to fix your hiccups?
• Do you have GERD?
• Is there a history of cancer in your family? Strokes? Tumors?
• Are you experiencing any other symptoms?

Management and Treatment

How do I treat hiccups?

Because the exact cause of hiccups is uncertain, some remedies may or may not work. These home treatments will not hurt you, so there is typically no harm in trying them. Home treatments include:

• Drinking water quickly.
• Swallowing granulated sugar, dry pieces of bread, or crushed ice.
• Gently pulling on your tongue.
• Gagging (sticking a finger down your throat).
• Gently rubbing your eyeballs.
• Gargling water.
• Holding your breath.
• Breathing into a paper bag (do not use a plastic bag).

Are there any medications I can take for serious hiccups?

Hiccups that last for a long time can be treated by medication. Prescription drugs used for long-lasting hiccups include:

• Gabapentin.
• Baclofen.
• Chlorpromazine.

What are the side effects of long-term hiccups?

• Trouble eating.
• Trouble sleeping (including insomnia) and feeling tired.
• Some people feel embarrassed.

How do I stop my kid’s hiccups?

Babies get hiccups just like children, teenagers and adults. In fact, even babies in the womb can get hiccups! Babies under 12 months often get hiccups and they’re unharmed by them. If you want, you can try to stop them by breastfeeding or giving them some water. However, if the hiccups don’t stop after a couple of hours, see your healthcare provider.

Kids can try the home treatments listed above.

Never hesitate to contact your pediatrician if you have a concern about your child.

Prevention

How are hiccups prevented?

Sometimes medications taken before a treatment can prevent hiccups from happening. For example, hiccups caused by anesthesia can be prevented by taking metoclopramide beforehand. Steroids with ramosetron might prevent chemotherapy-related hiccups.

Again, mild hiccups (those that go away in a short interval) can happen because of the following. Therefore, you may try to avoid the following to prevent hiccups from happening. Try not to:

• Eat and drink too quickly.
• Drink carbonated beverages or alcohol
• Eat too much.
• Experience stress – including fear and excitement.
• Over-stretch your neck.
• Take drugs (particularly those for anxiety – benzodiazepines).
• Drink a very hot or very cold drink.
• Go through chemotherapy.
• Are anesthetized for a procedure.
• Inhale toxic fumes.

Outlook / Prognosis

How long will I have hiccups?

Hiccups can last minutes, hours, days or, if severe, weeks. The longest known and recorded bout of hiccups lasted 60 years!

Can hiccups go away on their own?

Yes. Often no treatment is needed, either home remedies or treatment provided by your healthcare provider.

Living With

Can I live a normal life with hiccups?

Hiccups shouldn’t prevent you from enjoying your daily activities.

When should I go see a healthcare provider?

If your hiccups last only minutes to a couple of hours, you probably don’t need to see your healthcare provider. However, if the hiccups last more than a few days (typically two), you should see him or her. When the hiccups happen at the same time as symptoms like a headache, trouble keeping your balance, or numbness, it can be a sign of something more serious. If you have those symptoms with hiccups, see your healthcare provider immediately or go to the nearest emergency room.

A note from Cleveland Clinic

Hiccups are usually harmless. Most stop without treatment, or with simple home remedies. They don’t reduce your quality of life. However, remember to keep an eye on how long they last. Hiccups may be a symptom of a serious illness, or they could just be annoying.

Hiccups: Causes & Treatment

Overview

What are hiccups?

Hiccups are repeated spasms of your diaphragm paired with a ‘hic’ sound from your vocal cords closing. Your diaphragm is a muscle under your ribcage, separating your chest and stomach area. This muscle is an important part of the breathing process. It moves downward when you breathe in and upward when you breathe out.

Two things happen when you hiccup:

• Your diaphragm pulls down between breaths, making you suck in air.
• The glottis (space between the vocal cords) closes to stop more air coming in.

These actions make the ‘hic’ sound of the hiccup. The process of the hiccup happens very quickly and you’ll usually return to normal within minutes to a couple of hours without treatment.

Can hiccups happen to anyone?

Yes. Hiccups can happen to adults, children and babies.

Who commonly gets hiccups?

Hiccups are more common in men. They can also have hiccups for a longer period.

Symptoms and Causes

What causes hiccups?

It’s not clear why people get hiccups. There are several reasons hiccups might happen, including low levels of carbon dioxide in the blood and irritated nerves. The phrenic nerve (which connects the neck to the diaphragm) and vagus nerve (which connects the brain to the stomach) are important parts of the breathing process.

Mild hiccups (those that go away in a short time) can happen when you:

• Eat and drink too quickly.
• Drink carbonated beverages or alcohol.
• Eat too much.
• Experience stress – including fear and excitement.
• Over-stretch your neck.
• Take drugs (particularly those for anxiety – benzodiazepines).
• Drink a very hot or very cold drink.
• Go through chemotherapy.
• Are anesthetized for a procedure.
• Inhale toxic fumes.

What does it mean if the hiccups last for more than two days?

If your hiccups don’t go away within a few days, they are called ‘persistent.’ If they last for a few months they are called ‘intractable’ (long-lasting hiccups). Long-lasting hiccups are rare. They can be stressful and exhausting. Intractable hiccups can be part of a larger, underlying medical problem and might not go away until that issue is corrected.

Some of these larger, underlying conditions include:

• Cancer and tumors.
• Stroke.
• Disorders of the stomach or esophagus, including GERD (a gastrointestinal and abdominal disorder).
• Pleurisy of the diaphragm.
• Uremia.
• Pneumonia.
• Bowel diseases.
• Pancreatitis and bladder irritation.
• Hepatitis and liver cancer.
• Tumors and lesions.

Hiccups can also happen after surgery and during the recovery process from a procedure. See a healthcare provider if your hiccups last for a long period of time.

Diagnosis and Tests

How are hiccups diagnosed?

Diagnosing hiccups is not complicated. Your healthcare provider needs only to listen to the ‘hic’ sound.

However, your healthcare provider may perform a physical examination to see if an underlying condition may be causing your hiccups. If the physical examination reveals anything of concern, he or she may order tests such as imaging tests, endoscopic tests and lab tests.

What questions might my healthcare provider ask?

• How long have you had hiccups?
• How often do you hiccup?
• Have you tried any home remedies to fix your hiccups?
• Are you interested in taking medication to fix your hiccups?
• Do you have GERD?
• Is there a history of cancer in your family? Strokes? Tumors?
• Are you experiencing any other symptoms?

Management and Treatment

How do I treat hiccups?

Because the exact cause of hiccups is uncertain, some remedies may or may not work. These home treatments will not hurt you, so there is typically no harm in trying them. Home treatments include:

• Drinking water quickly.
• Swallowing granulated sugar, dry pieces of bread, or crushed ice.
• Gently pulling on your tongue.
• Gagging (sticking a finger down your throat).
• Gently rubbing your eyeballs.
• Gargling water.
• Holding your breath.
• Breathing into a paper bag (do not use a plastic bag).

Are there any medications I can take for serious hiccups?

Hiccups that last for a long time can be treated by medication. Prescription drugs used for long-lasting hiccups include:

• Gabapentin.
• Baclofen.
• Chlorpromazine.

What are the side effects of long-term hiccups?

• Trouble eating.
• Trouble sleeping (including insomnia) and feeling tired.
• Some people feel embarrassed.

How do I stop my kid’s hiccups?

Babies get hiccups just like children, teenagers and adults. In fact, even babies in the womb can get hiccups! Babies under 12 months often get hiccups and they’re unharmed by them. If you want, you can try to stop them by breastfeeding or giving them some water. However, if the hiccups don’t stop after a couple of hours, see your healthcare provider.

Kids can try the home treatments listed above.

Never hesitate to contact your pediatrician if you have a concern about your child.

Prevention

How are hiccups prevented?

Sometimes medications taken before a treatment can prevent hiccups from happening. For example, hiccups caused by anesthesia can be prevented by taking metoclopramide beforehand. Steroids with ramosetron might prevent chemotherapy-related hiccups.

Again, mild hiccups (those that go away in a short interval) can happen because of the following. Therefore, you may try to avoid the following to prevent hiccups from happening. Try not to:

• Eat and drink too quickly.
• Drink carbonated beverages or alcohol
• Eat too much.
• Experience stress – including fear and excitement.
• Over-stretch your neck.
• Take drugs (particularly those for anxiety – benzodiazepines).
• Drink a very hot or very cold drink.
• Go through chemotherapy.
• Are anesthetized for a procedure.
• Inhale toxic fumes.

Outlook / Prognosis

How long will I have hiccups?

Hiccups can last minutes, hours, days or, if severe, weeks. The longest known and recorded bout of hiccups lasted 60 years!

Can hiccups go away on their own?

Yes. Often no treatment is needed, either home remedies or treatment provided by your healthcare provider.

Living With

Can I live a normal life with hiccups?

Hiccups shouldn’t prevent you from enjoying your daily activities.

When should I go see a healthcare provider?

If your hiccups last only minutes to a couple of hours, you probably don’t need to see your healthcare provider. However, if the hiccups last more than a few days (typically two), you should see him or her. When the hiccups happen at the same time as symptoms like a headache, trouble keeping your balance, or numbness, it can be a sign of something more serious. If you have those symptoms with hiccups, see your healthcare provider immediately or go to the nearest emergency room.

A note from Cleveland Clinic

Hiccups are usually harmless. Most stop without treatment, or with simple home remedies. They don’t reduce your quality of life. However, remember to keep an eye on how long they last. Hiccups may be a symptom of a serious illness, or they could just be annoying.

Remedies for Prolonged Hiccups – Letters to the Editor

Am Fam Physician. 2001 May 1;63(9):1684-1686.

to the editor: Hiccups are an annoyance to nearly everyone at one time or another. Fortunately, they are also usually self-limited and benign. It is unusual for persons to seek care for hiccups unless the episode is particularly prolonged. Prolonged hiccups, however, can be debilitating and may be a sign of serious underlying disease. Thus, when patients do present with hiccups for medical attention, it is important to evaluate for potentially serious underlying causes.

Hiccups are believed to be caused mainly by irritation of either the phrenic or vagus nerves anywhere along their paths.1  Central nervous system diseases, toxins, drugs and metabolic abnormalities may also lead to hiccups. The accompanying table1 lists some of the many diseases that have been reported to cause hiccups.

Hiccups lasting longer than two days are termed “persistent” and those lasting longer than one month are considered “intractable.”1 Intractable hiccups will frequently be a sign of underlying organic disease1; therefore, obtaining a thorough history and performing a physical examination is important to evaluate for potentially serious causes. The most useful studies are probably a chest radiograph and an electrolyte panel. Further studies can be ordered based on findings from the history and physical examination.

Many pharmacologic and nonpharmacologic remedies have been used to try to abort hiccups. Medications that have been reported to be effective include chlorpromazine (Thorazine),1,2 nifedipine (Procardia),3 haloperidol (Haldol),1,4 phenytoin (Dilantin),1 metoclopramide (Reglan),1 baclofen (Lioresal)1,5 and gabapentin (Neurontin).6 Surgical management has included such techniques as phrenic nerve interruption or placement of diaphragmatic pacemakers.1 Stimulating the nasopharynx with a rubber catheter and elevating the uvula with a cotton tip applicator or similar device have both been reported to be efficacious in the alleviation of hiccups.1

View/Print Table

Causes of Hiccups

Causes of Hiccups

Of any malady in medicine, hiccups probably have some of the most interesting home remedies. Perhaps the most well-known home remedy is breathing into a paper bag. This method (at least partly) relies on the observation that hiccups decreases as Pco₂ rises. Many of the home remedies either stimulate the nasopharynx or interrupt the normal respiratory cycle: holding one’s breath, being frightened (gasping), swallowing sugar and sipping ice water. Drinking from the far side of a glass is one home remedy that is probably interesting to watch even it doesn’t happen to work. We have also found that drinking a glass of water through a paper towel may be effective.

When you are seeing a patient with severe hiccups or (more commonly) when you or someone you know needs relief from hiccups, there are many (mostly anecdotal) effective methods you can try. And, for an interesting piece of trivia to impress the next harbinger of hiccups you meet, the medical term for hiccups is singultus.

The management of hiccups in terminally ill patients

According to Wilcock and Twycross (1996) hiccups are ‘caused by a sudden involuntary contraction of one or both sides of the diaphragm associated with closure of the glottis’.  

Abstract

VOL: 101, ISSUE: 31, PAGE NO: 32

Rachel Ann Phillips, BA in palliative care, is clinical nurse specialist, palliative care team, Wycombe General Hospital

Persistent hiccups are those that last more than 48 hours, whereas intractable hiccups are those that last more than one month (Lewis, 1985).

Common causes of hiccups in terminal disease include gastric distension, gastro-oesophageal reflux, diaphragmatic irritation, phrenic nerve irritation, toxicity and central nervous system tumour (Twycross and Wilcock, 2001).

Intractable hiccups are occasionally seen in patients with a terminal disease, and can be a distressing symptom for some. It is important to elicit from the patient how a symptom affects them as an individual, in order to be able to plan care that effectively improves their quality of life.

Nursing management

A review of the literature shows that the effective management of hiccups depends on the patient and how they respond to a particular pharmacological approach.

The case study in Box 1 describes a patient who had hiccups caused by gastric distension, the most common cause of hiccups in terminal illness (Wilcock and Twycross, 1996). Metoclopramide did not relieve the condition. However, other case reports have found metoclopramide to be effective (Slipman et al, 2001).

Wilcock and Twycross (1996) discuss the case of two terminally ill patients suffering with hiccups where chlorpromazine, metoclopramide, dexamethasone, haloperidol and baclofen were used, all of which had been ineffective. Midazolam was given to relieve the patient’s distress and the hiccups stopped.

In a study by Ramirez and Graham (1992) baclofen was evaluated in a double-blind randomised controlled trial and found to successfully terminate intractable hiccups. In this study, four men with intractable hiccups received baclofen and their hiccup-free periods increased by 69 per cent.

The use of pharmacological approaches has been questioned because of the potential for adverse reactions in patients who are terminally ill. De Ruysscher et al (1996) found that for one patient domperidone, chlorpromazine, haloperidol and nifedipine had been ineffective. However, the regular use of nebulised saline during the day and as required overnight was found to be effective.

Metoclopramide and baclofen aim to relieve gastric distension by improving gastric emptying and relaxing the diaphragm. They are also important to assess the patient’s bowel functioning and to treat constipation, if indicated, as this may be contributing to the gastric distension. If the hiccups are not resolved by this, haloperidol and chlorpromazine could be used with the aim of suppressing the hiccup reflex.

Non-pharmacological approaches (Box 2) are worth consideration but may not be appropriate for patients in the terminal stage of their disease. Alternative therapies such as acupuncture and hypnotherapy have been reported as effective treatments (Department of Health, 2002).

Impact on quality of life

An understanding of the palliative care needs of patients is based on the central concept of quality of life.

A broad understanding of a patient’s quality of life is achievable by asking them how they view their life. A more focused understanding can be obtained by asking how they view their symptoms and functioning.

Quality of life is subjective not only between individuals, but also for individual patients as they travel through their illness trajectory. This is a concept known as the response shift, where patients are able to change their perception of their quality of life accordingly as their illness progresses (Rees et al, 2004).

In palliative care, tools that can be used to measure a patient’s quality of life include the Quality-of-Life Index and the Hospice Quality-of-Life Index (McMillan, 1996). Such tools can be used to measure outcomes in health care but could be further developed to accurately measure quality of life in respect of the response shift (Rees et al, 2004).

Quality of life is multifaceted and can challenge an individual’s view of the world. In illness, the patient may be challenged by the symptoms they experience and question their psychosocial, spiritual and physical sense of self and the meaning this places on relationships with those close to them. These challenges may influence a patient’s decision-making with regard to treatment options as the side-effects of therapies may affect their quality of life (Mystakidou et al, 2002).

Hiccups can often cause severe distress and they can consequently affect the quality of life for some terminally ill patients. Indeed, persistent hiccups can effect the way patients talk, sleep, eat and drink, and in some can lead to weight loss, exhaustion, anxiety and depression (Wilcock and Twycross, 1996).

For example, the patient discussed in the case study (Box 1) was low in mood and despondent because of his persistent hiccups.

The levels of anxiety and emotional distress suffered by a patient may contribute to hiccups. In palliative care, understanding the patient’s perception of the impact of the symptom on his/her quality of life is essential in order to alleviate distress and promote comfort.

Conclusion

Self-awareness of communication skills is vital in order to achieve effective symptom management for patients. The NICE guidance Improving Supportive and Palliative Care for Adults with Cancer (NICE, 2004) highlights the importance of professionals being able to communicate with patients. Skills that encourage the patient to explore the impact the symptom has had on their quality of life from a physical, psychosocial and spiritual perspective is fundamental in palliative care.

Reflective practice may help professionals to question and challenge assumptions about quality of life and what may be considered to be ‘normal’. Implementing a tool into clinical practice to measure quality of life for patients may improve the outcome of patients’ care.

The effective management of symptoms (hiccups being an example) is dependent not only on a number of clinical approaches but also on the support offered by the multidisciplinary team. Listening to the patient’s feelings and fears may help them to put the symptom into context and help them to view their quality of life with new hope and meaning.

Learning objectives

Each week Nursing Times publishes a guided learning article with reflection points to help you with your CPD. After reading the article you should be able to:

– Explain the physiological causes of hiccups;

– Understand the effect of hiccups on a patient’s quality of life;

– Know the pharmacological interventions for hiccups;

– Describe the non-pharmacological interventions for hiccups.

Guided reflection

Use the following points to write a reflection for your PREP portfolio:

– Write about why the subject of hiccups is relevant to your area of practice;

– Outline the main points the article makes;

– Identify a fresh piece of information you have learnt about hiccups;

– Consider how you could use this information in your future practice;

– Explain how you will follow up what you have learnt.

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Treatment for long-lasting hiccups

Chronic hiccups or long-lasting hiccups refers to involuntary, sudden spasms of the diaphragm (the muscle that separates the abdominal and chest cavities), followed by rapid closure of the vocal cords and the production of a “hiccup” sound at the top of the windpipe.

Hiccups usually last for a short period of time, generally minutes or hours, but chronic hiccups persist for extended periods (more than two days) and sometimes for longer than a month.

Prognosis

The prognosis for people with chronic hiccups depends on the underlying cause of the problem, which can vary in severity. Regardless of the cause, but depending on how long the hiccups last, the condition can eventually disrupt sleeping and eating patterns, leading to complications such as exhaustion, dehydration, and weight loss.

Cause

The underlying cause of chronic hiccups often cannot be determined, but cases may be caused by various health conditions such as those that affect the central nervous system or irritate the diaphragm, psychological problems, and metabolic diseases. Other causes include surgery and the use of certain medications.

• If the underlying cause of chronic hiccups can be determined, treatments can be used to target and relieve the problem. The tests a doctor may carry out in order to establish the cause include physical examination, laboratory tests, imaging tests, and endoscopic tests.
• Physical examination – Neurological tests may be carried out in order to help check balance, coordination, muscle strength, muscle tone, sight, sense of touch, and reflexes.
• Laboratory tests – These may include blood tests to check for infection or metabolic diseases such as diabetes or kidney conditions.
• Imaging tests – These may be performed to look for any abnormalities that may be affecting the diaphragm or the nerves that serve the diaphragm, specifically the vagus nerve and phrenic nerve. Examples include computerized tomography, magnetic resonance imaging, and X-ray.
• Endoscopy tests – Here, a small, bendy tube with a camera attached at one end is passed down the throat to check that the esophagus and windpipe are healthy.

Treatment

In cases where an underlying cause can be established, treating the problem can resolve the hiccups. For example, if a person is found to have gastro-esophageal reflux disease, a drug called a proton pump inhibitor may be prescribed, which reduces the level of acid present in the stomach. Medical conditions thought to be causing the hiccups may require evaluation by a specialist, in which case the patient is referred by their doctor so that further tests can be performed and the appropriate treatment recommended.

In cases of chronic hiccups that fail to respond to treatment and where no cause can be determined, a patient may be prescribed medications specifically designed to alleviate hiccups.

One of these medications is usually prescribed for a period of several weeks, with the dose gradually being increased, if necessary, to bring the problem under control. Following this, the dose is then gradually reduced until it is no longer necessary to take the drug. If the hiccups return once the dose is reduced or after the medication is stopped, a patient may be prescribed an increased dose again or advised to start the treatment again. If the initial drug prescribed still fails to resolve the problem, an alternative medication may be suggested. All of the drugs used to treat hiccups can cause side effects and individuals must ensure they discuss these with their doctor before initiating treatment.

If a patient fails to respond to medication for their hiccups, injection of an anesthetic that blocks the phrenic nerve may be recommended. Another procedure that may be advised is the surgical implantation of a device that electrically stimulates the vagus nerve.

Further Reading

90,000 causes, symptoms, diagnosis, treatment, prevention

Non-specific breathing disorder, manifested by involuntary and abrupt movements of the diaphragm on exhalation. During inhalation, there is a sharp narrowing of the diaphragm or closure of the glottis, in connection with which the occurrence of typical sounds is observed.

Causes

Hiccups often develop in perfectly healthy people. It can appear with severe hypothermia, excessive overeating, severe alcohol intoxication, severe emotional shock, rapid absorption of food, intake of strongly carbonated drinks, involuntary swallowing of air, bloating associated with the intake of foods that contribute to gas formation, as well as fright, accompanied by a sharp exhalation.In most cases, it stops on its own and does not threaten human life.

Sometimes this symptom is a sign of illness. Hiccups can occur against the background of diseases of the digestive tract, tumor lesions of the central nervous system, acute myocardial infarction and chest injuries.

There are several types of hiccups in total:

peripheral, develops with irritation of the vagus nerve passing from the chest into the peritoneal cavity, through a narrow phrenic opening, or phrenic nerve;

central, develops with irritation or damage to certain centers in the brain, is associated with craniocerebral trauma, as well as mental disorders and lesions of the nervous system;

toxic, appears against the background of poisoning;

rejection, occurs with parasitic and inflammatory bowel lesions.

Symptoms

Hiccups are accompanied by typical sounds from the oral cavity at short intervals. During hiccups, an involuntary intense contraction of the diaphragm is observed, accompanied by short breaths and protrusion of the anterior abdominal wall.

This disorder often occurs after eating in newborns and young children, who are distracted while eating. In infants, hiccups are often accompanied by mild regurgitation.

Prolonged hiccups in most cases occurs against the background of diseases. In this case, the development of her frequent attacks is observed, which is accompanied by the occurrence of severe psychological discomfort in the patient.

Diagnostics

Short attacks of hiccups are absolutely safe. Quite another matter is the indomitable hiccups lasting for several hours and even days, characterized by frequent repetitions. In this case, the patient may require a comprehensive examination.

Treatment

Short hiccups do not require treatment; they disappear quickly on their own. To get rid of hiccups in this case, it is advisable to use folk methods. Experts advise that in order to quickly eliminate hiccups, it is enough to just hold your breath or perform a deep and intense coughing.

With prolonged recurrent hiccups, the patient is prescribed anticonvulsants or antipsychotics, such as dopamine, bromocriptine, bromidem.

Prevention

To prevent the development of short hiccups, avoid hypothermia, abuse of drinks containing alcohol, and fast food intake.

To prevent the development of pathological hiccups, it will be necessary to eliminate the causes that caused it.

treatment in Kiev at the Oxford Medical clinic

Dyskinesia of the stomach and duodenum is a violation of the contractile and / or evacuation function of the stomach and duodenum, which is accompanied by an increase or decrease in the time spent by food in these organs.

CAUSES AND SYMPTOMS OF DYSKINESIA OF THE GASTROINAL TRACT

The cause of dyskinesia of the stomach and duodenum can be: stressful situations, improper diet, too fast food intake without proper chewing, the use of excessive amounts of carbohydrates, lack of nutrients toxins (alcohol, smoking), damage to the central and autonomic nervous systems (while taking certain drugs). Dyskinesia caused by such external factors is called exogenous.There is also an endogenous type, the appearance of which is caused by the pathology of other organs:

• peptic ulcer diseases;

• biliary tract disease;

• parasitic diseases;

• gastric vascular thrombosis;

• peritonitis;

• pneumonia;

• myocardial infarction.

The main symptoms of dyskinesia are: pain, heaviness, a feeling of fullness in the epigastric region, hiccups, heartburn, sour belching, vomiting of greenish fluid, dull pain in the stomach.At the same time, organic changes cannot be detected during endoscopy and histological examination. This is explained by the fact that most often the development of symptoms is associated with mental trauma and stress.

METHODS OF TREATMENT AND PREVENTION OF STOMACH AND DUAL DYSKINESIA

In the treatment of gastric dyskinesia, first of all, probing is performed in order to free the organ from its contents. Then drainage is carried out, which is installed until the stomach is fully restored.The main goal of treatment is to find the disease that caused the dyskinesia and treat it. As a method of dealing with dehydration, droppers can be used, peristalsis is stimulated (with atony of the stomach) and its tone is increased. Psychotherapeutic assistance and sedatives have a positive effect.

Prevention of dyskinesia and duodenal ulcers is the timely treatment of diseases of the gastrointestinal tract, you need to avoid stressful situations, correctly combine work and rest, eat right.

DIAGNOSIS AND TREATMENT OF GASTRIC DYSKINESIA IN THE OXFORD MEDICAL CLINIC

The Oxford Medical clinic uses an endoscopic examination method. During the course of treatment, the patient receives advice on diet and diet. Prescribed medication for the gastrointestinal tract.

The treatment of gastric dyskinesia takes place in a day hospital and is accompanied by antispasmodic therapy and influence on the conduction of the nervous system. In serious conditions, surgical intervention is prescribed.

High professionalism and quality of service at the Oxford Medical clinic are due to the following factors:

• long-term experience of specialists;

• high-quality diagnostics using expert-class equipment;

• individual approach to the patient, prescription of treatment, taking into account the peculiarities of the work of his body;

• Use of the latest and most effective drugs in drug treatment.

You can make an appointment at the gastroenterology department of the Oxford Medical clinic by phone or through the form on the website.

An unusual symptom of COVID-19 is known

Persistent hiccups became the main reason for seeking emergency medical care for a 62-year-old patient who, as a result of a thorough examination, was diagnosed with the coronavirus COVID-19. His case is reported in The American Journal of Emergency Medicine.

In addition to hiccups for 4 days, the man complained of unintentional loss of 25 pounds (11.34 kilograms) in the previous four months. He had no cancer or lung diseases in the past.

An abnormal X-ray of the patient’s chest organs prompted doctors to resort to computed tomography, which showed the effect of “ground glass” in his lungs. He was hospitalized, then tested positive for COVID-19.The patient received the drug hydroxychloroquine and symptomatic treatment. Three days after hospitalization, he was discharged in a stable condition.

The authors of the article note the importance of a detailed examination of patients presenting with hiccups – at least they need to take basic tests and do a chest x-ray. Also, doctors recommend to their colleagues to keep in mind the possibility of coronavirus infection in their patients, as more and more cases are detected during atypical requests for medical help.

Meanwhile, the Chinese media are writing about the spread of a dangerous virus in the country, which enters the human body through tick bites and can be transmitted from a sick person to a healthy person. The main symptoms of the SFTS virus are fever, cough, vomiting, diarrhea, and a decrease in the number of leukocytes and platelets in the blood. In severe cases, patients may develop multiple organ failure.

According to Chinese media reports, in the first half of 2020, more than 37 infected with this virus were detected in the eastern Chinese province of Jiangsu, later 23 more cases were detected in Anhui province. Seven cases in Anhui and Zhejiang provinces have died.

90,000 Fetal Hiccups During Pregnancy: Expert Advice – Into-Sana

Many expectant mothers in late pregnancy experience the so-called fetal hiccups. What it is and how to prevent it, says a gynecologist of the highest category, Mikilyuk Alla Valentinovna, a doctor at the Into-Sana medical centers.

The sensations that a pregnant woman experiences as a “hiccup” of the fetus can be felt from the 28th week of pregnancy.Physiologically, this condition is explained by the contraction of the fetal diaphragm (the muscles that separate the chest and abdominal cavities).

Fetal hiccups are manifested by the sensation of short thrusts (some women call this clicks), which do not cause pain or discomfort. This condition can occur frequently or rarely, lasting from five to twenty minutes. There can be two reasons for the so-called “hiccup” of the fetus. The first is the swallowing of too much amniotic fluid by the fetus, in which it is located in the uterine cavity.In this case, the fetal diaphragm reacts to a full stomach and involuntary contraction occurs. Another, more dangerous reason is fetal hypoxia (oxygen starvation). At the same time, one of the nerve centers of the fetal brain is irritated, and it transmits impulses to the contraction of the diaphragm.

If “hiccups” occurs frequently or lasts a long time, you should definitely contact an obstetrician-gynecologist.

First of all, from the examinations it is necessary to do cardiotachography (study of the fetal heart rate) and ultrasound with doppler (this examination makes it possible to assess the blood flow in the vessels of the umbilical cord and in the placenta).A warning sign for a pregnant woman may be a combination of “hiccups” and an increase in fetal motor activity, as well as a fetal heart rhythm disorder detected by a doctor.

How to prevent fetal hiccups?

Prevention of “hiccups”, and, accordingly, fetal hypoxia, is the correct preparation of a woman for pregnancy: treatment of gynecological and non-gynecological diseases, infections, minimization of stress conditions; proper rest and work during pregnancy, adequate sleep, frequent walks in the fresh air. And in the presence of fetal hypoxia – elimination of its causes and treatment.

90,000 Hiccups: Why Hiccups? | Symptoms, cause, diagnosis and treatment

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Hiccups are uncontrolled contractions of the diaphragm, the muscle that separates the chest from the abdomen and plays a vital role in respiratory function. Each contraction of the hiccups is accompanied by lightning-fast closure of the vocal cords, which leads to the characteristic sound of hiccups. Questions? Feel free to subscribe and love us too via social networks .

Some common causes of hiccups are large meals, alcohol or soft drinks. But in some cases, hiccups can also be a sign of an underlying medical condition. For most of us, hiccups only last a few minutes before they resolve on their own, but for some, hiccups can last for months. These persistent hiccups can lead to weight loss and fatigue.

symptoms

Hiccups are a symptom in themselves. Sometimes, hiccups can also be felt in the chest, abdomen, or neck as a constricting sensation.

When to see a doctor

Consult a healthcare professional if hiccups persist for more than 48 hours, or if the hiccups are severe enough to cause trouble eating, sleeping, or breathing.

Reason: Why are you starting to hiccup?

Again, we want to distinguish between short-term and long-term hiccups. By long term crashes, we mean hiccups that lasted more than 48 hours.

Most common causes of short-term hiccups:

• Carbonated drinks
• Too much alcohol
• overeating
• Emotional stress
• Sudden temperature changes
• Air swallowing due to chewing gum

Common Causes of Prolonged Hiccups:

One of the causes of prolonged hiccups is irritation or damage to the vagus or phrenic nerve, that is, the nerves that supply power to the diaphragm. Causes that can damage or irritate these nerves include the following:

• Hair or something similar inside the ear – falls into the eardrum.
• Tumor, tumor or cyst in the neck / neck
• GERD – acid regurgitation and acid reflux
• Laryngitis or sore throat
• Disease of the central nerve

A tumor or infection that affects the central nervous system may interfere with the body’s natural control of the hiccup reflex.Some examples that can affect the central nervous system:

• meningitis
• encephalitis
• Multiple sclerosis
• Slag
• Traumatic brain injury
• tumors
• Medicines and medicines

Prolonged hiccups can also be caused by:

• Alcoholism
• Anesthesia (e.g. during surgery)
• Diabetes / Diabetes
• Electrolyte imbalance
• Kidney disease
• steroids
• pain relievers
• drugs
• Surgery (especially stomach areas)

Who is most likely to suffer from hiccups?

Men are at significantly higher risk than women with prolonged hiccups.

Diagnosis: How to diagnose long-term hiccups and its cause?

The doctor will conduct a physical examination and ask you a series of questions. A neurologic examination may also be performed when the doctor checks for the following:

• Balance and Coordination
• Muscle strength and tone
• Reflectors
• Sensory and skin sensations with dermatomes

If your doctor suspects that something more serious is causing your prolonged hiccups, he or she may refer you for further tests, such as:

Blood tests and laboratory tests

Your blood and blood levels will be checked for clinical signs of diabetes, infection, kidney disease, or the like.

image processing

Imaging, such as MRI and X-rays, can help detect and visualize abnormalities affecting the vagus nerve or diaphragm. Some examples of such image tests:

• Chest X-ray
• CT
• MR
• gastroscopy

Treatment: how to treat prolonged hiccups to get rid of them?

As mentioned earlier, the vast majority of hiccups go away on their own, but if the hiccups are caused by diagnoses of the disease, then the doctor treats the disease itself and thus stops the hiccups, which are a symptom.

Medication is the most common used for prolonged hiccups that have lasted more than two days. Some examples of medicine used in such treatment for hiccups:

• Baclofen
• chlorpromazine
• Metoclopramide

Operation or injection

If the medication doesn’t work, your doctor may recommend an injection (such as anesthesia) to block the phrenic nerve and thus stop the hiccups.It has also been observed that a device used in epilepsy, a battery-operated device that provides gentle electrical stimulation to the vagus nerve, can be used. Then it will be implanted.

Natural Treatment, Diet & Advice

There are a number of tips and tricks for natural women, including:

• Breathe in paper bag
• Gargle with ice water
• Hold your breath (not too long!)
• Drink cold water

Next page: – This You Should Know About Crystal Disease (You will find a great review article about the crystal sick here)

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