What causes hiccups in babies. How are hiccups related to acid reflux. What are the best ways to stop baby hiccups. When should parents be concerned about infant hiccups. How can feeding techniques help prevent hiccups in babies.

The Science Behind Baby Hiccups

Hiccups are a common occurrence in babies, often causing more concern for parents than discomfort for the infant. But what exactly causes these tiny ‘hics’? Hiccups result from involuntary contractions of the diaphragm, the muscle separating the chest cavity from the abdominal cavity. This contraction is followed by a sudden closure of the vocal cords, producing the characteristic hiccup sound.

Interestingly, babies can experience hiccups even before birth. Many pregnant women report feeling these rhythmic movements in their bellies. After birth, hiccups are particularly common in newborns and infants.

Why are hiccups so prevalent in babies?

While the exact reason remains unclear, increased gas in the stomach is a likely culprit. Dr. Kylie Liermann, a pediatrician, explains, “If babies overfeed or gulp air during eating, that could cause the stomach to expand and rub against the diaphragm, generating those hiccups.” This explanation sheds light on why feeding times often trigger hiccup episodes in infants.

The Link Between Hiccups and Gastroesophageal Reflux

While hiccups are usually harmless, they can sometimes be a sign of gastroesophageal reflux (GERD). GERD occurs when stomach acid backs up into the baby’s esophagus. However, it’s important to note that hiccups alone are not a definitive indicator of GERD.

How can parents distinguish between normal hiccups and those caused by GERD?

If your baby has GERD, hiccups will likely be accompanied by other symptoms. These may include:

• Frequent coughing
• Excessive spitting up
• Irritability and crying, especially during or after feeding
• Arching of the back

If you notice these signs in conjunction with persistent hiccups, it’s advisable to consult your pediatrician. They can help determine if your baby is experiencing reflux and suggest appropriate management strategies.

Effective Strategies to Stop Baby Hiccups

For most babies, hiccups are a minor nuisance that will resolve on their own. However, if you’re looking to help your little one find relief, there are several strategies you can try:

Adjust Feeding Positions

One simple yet effective method is to change your baby’s feeding position. Try feeding your infant in a more upright position. Propping your baby up slightly can help reduce the amount of air they swallow during feeding, potentially preventing hiccups from occurring.

Increase Burping Frequency

Burping plays a crucial role in preventing hiccups. Dr. Liermann advises, “Burping usually helps with hiccups.” To implement this strategy, try taking a burp break after every 2-3 ounces of formula or switching breasts if you’re breastfeeding. This can help release trapped air before it leads to hiccups.

The Role of Feeding Techniques in Hiccup Prevention

The way you feed your baby can significantly impact the occurrence of hiccups. Here are some techniques that may help:

1. Paced bottle feeding: This method mimics breastfeeding and can help reduce air intake.
2. Proper latch: Ensure your baby has a good latch during breastfeeding to minimize air swallowing.
3. Smaller, more frequent feeds: This can prevent overfeeding and reduce the likelihood of hiccups.
4. Slow-flow nipples: These can help control the flow of milk, reducing the chance of your baby gulping air.

When to Be Concerned About Baby Hiccups

While hiccups are generally harmless, there are instances when they might warrant medical attention. If hiccups are frequent, prolonged, or seem to cause distress to your baby, it’s worth discussing with your pediatrician.

Are there any red flags parents should watch for regarding baby hiccups?

While rare, persistent hiccups accompanied by other symptoms could indicate an underlying condition. Be alert if hiccups are associated with:

• Difficulty feeding or swallowing
• Projectile vomiting
• Failure to gain weight
• Chronic coughing or choking

If you observe any of these symptoms, it’s crucial to seek medical advice promptly. Your pediatrician can conduct a thorough evaluation to rule out any serious conditions.

Hiccups in Older Infants and Toddlers

As babies grow, the frequency of hiccups often decreases. However, older infants and toddlers can still experience hiccups. At this age, hiccups might be triggered by:

• Eating too quickly
• Swallowing air while drinking
• Carbonated beverages (if introduced)
• Excitement or sudden changes in temperature

How can parents help older infants and toddlers with hiccups?

For older babies and toddlers, you can try some additional strategies:

1. Offer a drink of water
2. Encourage slower eating
3. Use distraction techniques
4. Gently rubbing or patting the back

Remember, hiccups in older children are usually short-lived and resolve on their own. If hiccups persist or cause discomfort, consult your healthcare provider.

Debunking Common Myths About Baby Hiccups

There are numerous old wives’ tales and myths surrounding baby hiccups. Let’s address some of these misconceptions:

Myth 1: Hiccups mean the baby is growing

This is a common misconception. While hiccups are normal in babies, they are not directly related to growth spurts.

Myth 2: Startling a baby will cure hiccups

This method is not recommended and could potentially upset your baby. It’s best to let hiccups resolve naturally or use gentle, pediatrician-approved methods.

Myth 3: Hiccups always indicate a feeding problem

While feeding can trigger hiccups, they can also occur for various other reasons and are often harmless.

Myth 4: Sugar on the tongue cures hiccups

This old remedy is not suitable for babies and could be dangerous. Never give infants sugar or any solid foods unless advised by your pediatrician.

The Impact of Hiccups on Baby’s Sleep

Many parents worry about hiccups disrupting their baby’s sleep. While hiccups can occur during sleep, they often don’t wake or bother the baby. However, if you notice your baby seems uncomfortable:

• Try changing their position slightly
• Ensure they’re not overheated or too cold
• Check if they need a diaper change or feeding

If hiccups consistently disrupt your baby’s sleep, discuss this with your pediatrician. They may want to rule out any underlying issues like reflux.

Hiccups and Baby’s Developmental Milestones

Hiccups are a normal part of infant physiology and don’t typically affect a baby’s development. However, how a baby responds to hiccups can be an interesting indicator of their sensory development.

How do babies’ reactions to hiccups change as they grow?

Newborns may not react to hiccups at all. As babies grow, you might notice:

• Around 2-3 months: They might start to notice the sensation
• 4-6 months: They might show surprise or amusement at the hiccup sound
• 6+ months: They might try to mimic the hiccup sound

These reactions are all normal and can be signs of healthy sensory and cognitive development.

The Role of Genetics in Baby Hiccups

While research in this area is limited, there’s some evidence to suggest that the tendency to hiccup might have a genetic component. Some families report that hiccups are more common across generations.

Can a family history of frequent hiccups predict a baby’s likelihood of experiencing them?

While not definitive, if parents or siblings experienced frequent hiccups as infants, it might increase the likelihood of a baby having similar experiences. However, environmental factors like feeding practices likely play a more significant role.

Hiccups in Premature Babies

Hiccups are particularly common in premature babies. This is thought to be due to the immaturity of their nervous system and digestive tract.

Are hiccups in premature babies a cause for concern?

Generally, hiccups in preemies are not a cause for alarm. However, frequent hiccups in premature infants should be monitored, as they could potentially interfere with feeding and weight gain. Neonatal care units often have specific protocols for managing hiccups in premature babies.

The Future of Hiccup Research in Infants

While hiccups might seem like a minor issue, ongoing research continues to explore their role in infant development. Some areas of current study include:

• The potential developmental benefits of hiccups in utero
• The relationship between hiccups and the maturation of the brain-body connection
• New, non-invasive methods to reduce problematic hiccups in infants

As our understanding of infant physiology grows, we may discover new insights into the role of hiccups in baby development and health.

Handling Hiccups – Complications – Acid Reflux

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What are hiccups?

According to the Mayo Clinic, hiccups are involuntary contractions of the diaphragm. The diaphragm is a large sheet of muscle that separates the chest cavity from the abdominal cavity. This muscle plays an important role in your breathing. When you have hiccups, each involuntary contraction of the diaphragm is followed by a sudden closure of your vocal cords, which makes the hiccup sound.

Does acid reflux cause hiccups?

Hiccups can be caused by a variety of reasons, such as eating too fast, eating too much, or drinking carbonated beverages. Hiccups also have been associated with acid reflux. Heartburn may irritate the diaphragm and cause it to contract. Even in infants, hiccups may be associated with reflux.

How are hiccups treated?

Most of the time, hiccups are annoying but not a serious problem. However, if hiccups last for more than a couple of days, they can irritate the diaphragm and disrupt eating and sleeping. They can also make acid reflux worse. A recent review of 15 published studies involving a total of 341 patients with persistent or intractable hiccups found no treatment that can safely and reliably stop the condition. Instead, researchers concluded that the most effective way to manage hiccups is to address the underlying condition.

If you suspect your acid reflux may be causing frequent hiccups, it is a good idea to talk to your doctor, who may treat your acid reflux more aggressively to see if this makes the hiccups disappear.

Dr. Tracy Davenport is a health writer, advocate and entrepreneur who has been helping individuals live their best life. She is co-author of Making Life Better for a Baby with Acid Reflux. Follow Tracy’s love of smoothies on Twitter.

Meet Our Writer

Tracy Davenport, Ph.D.

Davenport is the founder of Tracyshealthyliving.com. Using the latest scientific research, she helps people live their healthiest lives via one-on-one coaching, corporate talks, and sharing the more than 1,000 health-related articles she’s authored.

Here’s What to Do When Your Baby Has the Hiccups – Cleveland Clinic

Your brand new baby has a serious case of hiccups. And while they’re a little bit adorable, you’re also wondering if there’s any cause for concern.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

“Baby hiccups are very common, and they aren’t normally a problem,” says pediatrician Kylie Liermann, DO. “In fact, they usually bother parents more than the baby.”

To calm your new parent nerves a little, Dr. Liermann explains what causes baby hiccups and how to get rid of them so you (and baby) can breathe easier.

Why do babies get hiccups?

Hiccups are most likely caused by irritation to the diaphragm, the muscle at the base of the lungs. Sometimes, that muscle starts to spasm or cramp. That causes the vocal cords to clamp shut, creating that distinctive “hic!” sound you know and dread.

Developing babies can get hiccups even before they’re born, and many pregnant women have felt the telltale flutters in their bellies.

Hiccups are especially common in newborns and infants. “We don’t know exactly why, but hiccups may be caused by increased gas in the stomach,” Dr. Liermann says. “If babies overfeed or gulp air during eating, that could cause the stomach to expand and rub against the diaphragm, generating those hiccups.”

Hiccups and gastroesophageal reflux

Usually, hiccups don’t bother babies. But sometimes, hiccups are a sign of gastroesophageal reflux (GERD). Reflux causes stomach acid to back up into the baby’s esophagus.

If your baby has GERD, hiccups won’t be the only symptom, Dr. Liermann says. Infants with reflux also have signs such as:

• Coughing.
• Spitting up.
• Irritability and crying.
• Arching the back, especially during or after a feeding.

If you notice these signs, talk to your doctor about whether your baby might have reflux and how to manage it.

How to stop baby hiccups

If your baby doesn’t have reflux symptoms, don’t stress over hiccups, Dr. Liermann says. But if those little “hics!” are bothering you, there are some things you can try.

Change feeding positions

Try feeding your little one in a more upright position, Dr. Liermann suggests. Propping your baby up on a pillow so they aren’t lying flat may help them take in less air at mealtimes.

Burp more frequently

“Burping usually helps with hiccups,” Dr. Liermann says. Burp your baby during feeding to prevent hiccups from striking. Try taking a burp break after 2 or 3 ounces.

If you’re nursing, burp your baby before you switch sides. If your nugget already has hiccups, you can try to relieve them with some gentle pats on the back.

Reach for the binky

Pacifiers can sometimes stop hiccups in their tracks. “The sucking motion can help relax the diaphragm,” Dr. Liermann explains.

Give gripe water

Gripe water is an over-the-counter blend of herbs marketed as a treatment for colic and tummy troubles. Some parents find it helps with hiccups, too.

But above all, says Dr. Liermann: Don’t fret. “Hiccups stop on their own and don’t cause discomfort to babies. So don’t feel you need to treat them,” she says.

Hiccups – Gastrointestinal Society

The hiccup, hiccough, hicka, geehouk, hoquet, hipo, hikke, whatever you call it, nearly everyone has had this annoying experience. You may be wondering what causes them and, more importantly, how to stop them.

What are hiccups?

A hiccup is an often-repeated, breathing-related movement that does not serve any respiratory function. It involves a sudden, involuntary contraction of the diaphragm resulting in an abrupt intake of breath. The glottis (where the vocal chords are located) immediately closes in response, to prevent hyperventilation. This sudden closure halts the breath, causing it to strike the closed glottis, creating the familiar hic sound. People have been using the onomatopoeic word hiccup for approximately 500 years.

What activates hiccups?

There is no universal cause of hiccups, as they vary from person-to-person and incident-to-incident. It seems that in most cases, there is some type of irritation to nerves along the air pathway. Overeating, temperature change, excitement, consumption of alcohol, and excessive bloating seem to be the most common irritating triggers. Some other causes, particularly in chronic hiccupping, include trauma, infection, certain drugs, and problems with the central nervous system. Irritating stimuli such as spicy food, as well as digestive disorders such as gastritis, heartburn, peptic ulcers, and pancreatitis may occasionally start onset of hiccups.

There is evidence that hiccups could be a non-typical symptom of gastroesophageal reflux disease (GERD). In a 2009 article published in The European Journal of General Medicine,¹ physicians explained that two male patients who were suffering from chronic hiccupping made complete recoveries when using proton pump inhibitor (PPI) therapy. ² One of the men had been suffering from intermittent hiccupping for 15 years before beginning PPI treatment.

Why do we hiccup?

We know how hiccups occur and a number of potential triggers, but does this pesky condition occur for a good reason? Hiccupping is a common occurrence in fetuses, which leads to the theory that hiccups may be the way a fetus practices using its respiratory system before entering the world, where breathing becomes incredibly important. Once we’re born; however, hiccups don’t seem to serve any useful purpose. Another theory suggests that hiccups may be a remnant of a primitive reflex that we no longer need or use today. Speculations aside, it seems that the definitive purpose of hiccups remains a mystery.

How do we stop them?

When going through a bout of hiccups, the cure, the relief, the end of them is something quite sought after! As soon as a few hiccups burst out, people within earshot begin offering suggestions to get rid of them. Most of us have a favourite remedy we rely on, which eventually seems to work, whether or not our actions actually are what make them cease. Endless lists of cures flood the internet and libraries… from holding your breath, to sucking a lemon wedge soaked in bitters, the options are endless. However, medically speaking, what really works?

We can generalize the majority of effective cures into a few categories. There are those that increase the carbon dioxide level in the blood; which include holding your breath, breathing into a paper bag, chugging water (or any other beverage), and gargling. Methods that counter-stimulate the contractions of the diaphragm are also quite common; including lifting the knees into the chest, leaning forward, and applying ice to the area just under the rib cage. Swallowing a spoonful of sugar may also be helpful because it seems to modify nerve impulses, causing the diaphragm to stop the spasms.

If all else fails, maybe a folktale passed down in your family will be your cure! We hope something works for you, so you don’t end up like poor Charles Osborne, (1893-1991) who is the Guinness World Record holder of the title “The Man with the Longest Attack of Hiccups. ” His hiccups began on a routine day in 1922, while he was working on his farm. They continued for 68 years, until mysteriously stopping on June 5, 1990. Osborne hiccupped an estimated 430 million times in those 68 years, yet still managed to live a full life, marrying twice and having eight children! He died a year later due to complications from ulcers.

Folklore Hiccup Cures

Cures for the hiccups go back many years. Physicians and philosophers, Hippocrates, Celsus, and Galen, were firm believers that a good sneeze could end a bout of hiccups. However, scientist and philosopher, Plato, stood by his theory that a sudden thump on the back worked to scare away the hiccups. Some other classic cures include:

• smelling garlic
• sneezing
• yanking your tongue
• lifting your uvula with a spoon
• tickling the roof of your mouth, where the soft and hard palates meet, with a cotton swab
• chewing gum
• taking a shot of whiskey
• drinking warm milk through a straw
• chewing licorice root
• chewing and swallowing dry bread
• taking a swig of vinegar
• sucking on ice
• having someone give you a good scare

First published in the

Inside Tract® newsletter issue 175 – 2010

1.

Koçkar C, et al. Hiccup Due to Gastroesophageal Reflux Disease. Eur J Gen Med 2009; 6(4): 262-264
2. PPIs approved in Canada include omeprazole (Losec®), lansoprazole (Prevacid®), pantoprazole sodium (Pantoloc®), esomeprazole (Nexium®), rabeprazole (Pariet™), and pantoprazole magnesium (Tecta™).

Photo: © Valua Vitaly/Dreamstime.com

(PDF) Hiccup due to gastroesophageal reflux disease

263

Koçkar et al

European Journal of General Medicine

He was using doxazosin mesylate and non-steroidal

anti-inammatory drugs. On admission, temperature

was 36.5°C, blood pressure was 150/80 mmHg, and

pulse rate was 84/min. He had not obesity and re-

spiratory distress. Physical examination except mild

epigastric tenderness was normal. Findings on chest X

ray and ECG were also normal. Complete blood count

and biochemical tests were within normal limits. His

complaint had been continued during hospitaliza-

tion. Abdominal ultrasonography and computarized

tomography (CT) scan of the brain were normal.

Esophagogastroduedonoscopy (EGD) showed grade B

esophagitis according to Los Angeles classication (4),

pangastritis and erosive bulbitis.

Biopsies from esophagus and stomach were per-

formed. Omeprazol 20 mg bid and sucralfate 1 g

qid were initiated. Hiccup was resolved after third

day of the treatment. Gastric and esophageal biopsy

showed Barrett esophagus and chronic activated gas-

tritis. Helicobacter pylori (HP) infection was deter-

mined. Clarithromicine 500 mg/day and amoxiciline-

clavulonic acid 2 g/day, per oral were initiated for

eradication of HP. At the follow up, hiccup was not

repeated in last two years.

CASE 2

A 40 years-old man was admitted to our depart-

ment with complaints of hiccup for 6 days. Largactyl

was initiated. He reported retrosternal burning and

regurgitation for two years. Lansoprazol 30 mg bid

and sucralfate 1 g qid were initiated for GERD. He

only took once the drugs. He stopped drug treat-

ment. In history, he had infertile for two months. He

used gonodotropin (Pregnyl) and FSH, LH preperates

(Pergonal). On admission, temperature was 36.5°C,

blood pressure was 160/90 mmHg, and pulse rate

was 82/minute. Pulmonary, neurologic and cardiovas-

cular system exam were normal. His abdominal exam

was notable for mild epigastric tenderness. Complete

blood count and biochemical tests were within nor-

mal limits. Chest x-ray and electrocardiogram were

normal. Abdominal ultrasonography was normal. CT

scan of the brain was normal for etiology of hiccup.

EGD showed Los Angeles class grade A esophagitis.

PPI such as lansaprazol 30 mg/day and sucralfat

treatment were initiated. Hiccup was resolved after

fth day of the treatment. At the follow up, hiccup

was not repeated during last one year.

DISCUSSION

Hiccup is an involuntary, reex-like activity that be-

gins with contraction of the diaphragm shortly termi-

nated by the abrupt closure of the glottis (5). Hiccup

although a common annoyance of life, has been

linked with signicant morbidity and even death.

Causes of intractable hiccup include central ner-

vous system (CNS) lesions (neoplasms, hydrocephalus,

multiple sclerosis, syringomyelia, trauma, ischemia,

hemorrhage, infectious diseases, etc), toxic-metabolic

disorders (uremia, diabetes mellitus, alcohol, hypo-

natremia, gout, hypokalemia, etc), irritation of the

diaphragm or of the vagus nerve at several levels,

drugs ([alpha]-methyldopa, short-acting barbiturates,

dexamethasone, diazepam, chlordiazepoxide, CNS

stimulants, sulfonamides, and antiepileptic agents),

general anesthesia, postoperative causes, and psycho-

genic causes and may also be idiopathic (6).

Gastrointestinal stimuli can cause the reex excita-

tion of the neurons responsible for hiccup. It has

proposed that there are receptors in the esophagus

which when excited, send impulses through the vagus

nerve to the CNS, resulting in net excitation of the

respiratory motor neurons and hiccup (7). Esophageal

disorder during hiccup has signicance, in view of

the recent reported association between hiccup and

GERD (8).

Pooran et al reported four cases of hiccup due to se-

vere erosive esophagitis. These cases presented vari-

ous complaints such as epigatric pain, water brash,

regurgitation and retrosternal burning. Their patient’s

complaint, hiccup had improved with PPI therapy (9).

Shay et al reported a 67 years old man with heart-

burn, water brash and hiccups (10).

Dore et al evaluated the prevalence of atypical symp-

toms in a population of GERD patients. They found

that the prevalence of hiccup in GERD was 4.5%.

After PPI therapy, they showed that 0% for preva-

lence of hiccup (11). Bor et al. reported prevalence

of GERD symptoms in Turkey and found that preva-

lence of hiccup was 9.5% (12).

Our cases excluded other diseases in etiology of hic-

cups such as CNS disease, uremia, diabetes mellitus,

hyponatremia, gout and hypokalemia. They had not

consumed alcohol. They were not use drugs that

cause of hiccups. Our cases presented retrosternal

burning and regurgitation. An EGD showed esophagitis

in the two cases. We conclude that GERD may be

Hiccups and gastroesophageal reflux: Cause and effect?

2.

Shay SS, Myers RL, Johnson LF: Hiccups associated with reflux esophagitis. Gastroenterology 87:204–207, 1984

PubMed 

Google Scholar 

8.

Mittal RK, Rochester DF, McCallum RW: Effect of the diaphragmatic contraction on lower esophageal sphincter pressure in man. Gut 28:1564–1568, 1987

PubMed 

Google Scholar 

13.

Dodds WJ, Hogan WJ, Helm J: Pathogenesis of reflux esophagitis. Gastroenterology 81:376–394, 1981

PubMed 

Google Scholar 

Baby Hiccups | Colic SOS

I am asked so many times about a baby’s hiccups. What are they? What causes hiccups in newborns?

So, let me explain; a baby gets the hiccups when the diaphragm spasms due to air being in the stomach. It is normal for babies to get them occasionally, although often frustrating, they are not a cause for concern.

However if your baby gets hiccups frequently the it could be a symptom of colic or reflux.

The colicky baby

A baby is likely to get hiccups if they have swallowed too much air. This can be during feeding or even when they have been crying. Since one of the big causes of colic is due to air intake hiccups are often associated with colic.

The best way to prevent hiccups in your colicky baby is to manage the intake of air by ensuring that your baby has a good latch to either the breast or the bottle. Also try and be attuned to your baby’s feeding cues so that they do not cry to demand their feed. I realise that this is difficult, however when a baby cries they take in a lot of air just before feeding and this is likely to result in hiccups and uncomfortable tummies.

The reflux baby

A baby who has reflux is
also likely to get hiccups more frequently due to having more air in their stomachs and the spasms of
the oesophagus being irritated by the acid. It is one of the first symptoms to
look for when diagnosing a baby with silent reflux.

To prevent them in a baby with reflux, keep your baby upright for at least 30 minutes after each feed. This will help gravity do it’s job and keep the stomach contents down in the tummy rather than coming back up the oesophagus.

How to help your baby when hiccups strike

When your baby gets hiccups after feeding, try and wind them by keeping their oesophagus nice and straight so that the extra air can make it’s escape quicker and easier. A good winding technique is laying your baby over your knee, so that the pressure is on their tummy.  This will keep them nice and straight and the pressure of your knee on the tummy can help move the trapped wind. If your baby has a dummy then offer it to your baby, as the sucking action can help relieve the them too. For more information on how a baby benefits from sucking then read more here.

A Case of Obstructive Sleep Apnea, Gastroesophageal Reflux Disease, and Chronic Hiccups: Will CPAP Help?

INTRODUCTION

A 60-year-old African American man with past medical history of coronary artery disease, diabetes mellitus, gastroesophageal reflux disease (GERD), hypertension, and asthma presented for evaluation of possible sleep disordered breathing. During the visit, frequent hiccups were noted. The hiccups started one year ago, were temporarily relieved with omeprazole 20 mg once a day, and became intractable in the last month. He denied nausea, vomiting, diarrhea, or weight loss.

Daily medications included amlodipine 10 mg, clopidogrel 75 mg, doxazosin 4 mg, lisinopril 10 mg, furosemide 20 mg, omeprazole 20 mg, pravastatin 40 mg, ranitidine 150 mg, glipizide 10 mg, metoprolol 25 mg, and albuterol metered dose inhaler. He smoked a half-pack of cigarettes per day for 40 years. He denied alcohol or drug use. Family history included hypertension, diabetes, and stroke.

Physical exam revealed an obese male (body mass index 37) with hiccups approximately every 3 seconds. Mild inferior nasal turbinate hypertrophy was noted bilaterally. Oral airway evaluation showed an enlarged tongue with a Mallampati score of 4. The remainder of his physical examination and neurological examination was normal.

Chest x-ray and non-contrast head computerized tomography (CT) were unremarkable. Magnetic resonance imaging of the brain with and without gadolinium contrast showed mild subcortical white matter ischemic changes. A non-contrast CT of the chest showed diffuse esophageal thickening, and esophagogastroduodenoscopy (EGD) revealed severe chronic esophagitis with a 5-cm ulcer.

A split-night polysomnogram showed evidence of severe obstructive sleep apnea (OSA). The apnea index was 107 events per hour. Hypopneas were not seen during the diagnostic portion of the study. A representative 60-sec epoch is shown in Figure 1. Continuous positive airway pressure (CPAP) titration with a full-face mask showed resolution of sleep disordered breathing at a pressure of 18 cm of water.

Figure 1: 60-second epoch during sleep stage N2

This figure depicts an obstructive apneic event as noted by absence of flow in the thermistor for > 10 sec and paradoxical contractions in the thoracic and abdominal effort channels.

QUESTION

What is the cause of the event depicted by the red arrow in this 60-sec epoch (Figure 1)?

ANSWER

A hiccup during an obstructive apneic event.

DISCUSSION

Chronic persistent hiccups can be debilitating and have been associated with weight loss, insomnia, and fatigue. They can be caused by a wide variety of medical conditions, including central nervous system abnormalities, metabolic imbalances, and chest and abdomen pathology. Among the medications known to cause hiccups, the most common include corticosteroids, antidepressants, dopaminergics, and opioids.¹

Chronic hiccups can persist during sleep and tend to decrease in frequency during N2, N3, and REM sleep.² In our patient hiccups during wakefulness occurred approximately every 3 seconds. During N1, hiccups occurred approximately every 4 to 5 seconds. During N2, the interval between hiccups gradually increased from 6 sec to > 20 sec. No hiccups were noted during REM sleep. The patient did not achieve N3. Hiccups were absent during the CPAP titration portion of the study, both during wakefulness and sleep. During obstructive apneas hiccups persisted and hiccup frequency was unaffected (Figure 1). Hiccups occurred during inspiration and were not usually associated with arousals (Figure 2). During the titration portion of the study, the frequency of apneas decreased and hypopneas became apparent. Hiccups were not seen during the CPAP titration. Even though a relationship between obstructive apneas and hiccups has not been established, the appearance of hypopneas after the resolution of hiccups may indicate an association between hiccups and complete upper airway closure.

Figure 2: 30-sec epoch during sleep stage N2

Red arrows indicate thoracic-abdominal movements secondary to hiccups as confirmed by review of the video monitoring. Note that the hiccups are not associated with arousals.

A hiccup center has been postulated in the brainstem. Efferent pathways travel mainly to the diaphragm, glottis, and esophagus³; with activation of these pathways resulting in forceful respiratory muscle contraction, followed by closure of the glottis and a rapid drop in intrathoracic pressure. This drop in intrathoracic pressure may cause air to move out of the stomach into the esophagus and/or food to move from the oral cavity/upper esophagus into the lower esophagus.

Esophageal pathology including erosive esophagitis secondary to GERD has been associated with hiccups and when appropriately treated, has been reported to resolve hiccups. It has also been postulated that hiccups can worsen GERD by increasing gastric pressure secondary to diaphragmatic contractions or by negative esophageal pressure with decreased lower esophageal sphincter (LES) tone during the hiccups.⁴ The most likely cause of persistent hiccups in our patient is erosive esophagitis. Persistent hiccups have also been reported as the initial presentation of esophageal carcinoma making EGD evaluation and esophageal biopsy critical in these patients.

CPAP alters esophageal function by increasing intrathoracic pressure, compressing the esophagus, and decreasing the pressure gradient associated with the diaphragm. CPAP increases basal LES pressure, esophageal pressure, and gastric pressure, while simultaneously decreasing the duration of LES relaxation when swallowing. This results in a decreased number of reflux events with CPAP use.⁵ CPAP induced intrathoracic pressure elevation may prevent the pressure drop responsible for hiccups, thereby resulting in either reduced hiccup frequency or complete resolution.⁶ The common practice of breath holding with the mouth and nose closed may also alleviate hiccups through a similar mechanism. Our patient is stable on CPAP and is taking omeprazole 20 mg twice a day. Nighttime hiccups have resolved and daytime hiccups are now rare.

CLINICAL PEARLS

1. Hiccups can persist during sleep; however, hiccup frequency decreases compared to wakefulness.

2. Hiccups occur during inspiration.

3. Gastroesophageal reflux is a common cause of chronic hiccups; however, other causes of chronic persistent hiccups should also be evaluated

4. CPAP eliminated hiccups in this patient with obstructive sleep apnea and severe esophagitis

CITATION

DelRosso L; Hoque R. A case of obstructive sleep apnea, gastroesophageal reflux disease, and chronic hiccups: will CPAP help? J Clin Sleep Med 2013;9(1):92–95.

DISCLOSURE STATEMENT

The authors have indicated no financial conflicts of interest.

REFERENCES

• 1 Bagheri H, Cismondo S, Montastruc JL[Drug-induced hiccup: a review of the France pharmacologic vigilance database]. Therapie; 1999;54:35-9, 10216420.

• 2 Arnulf I, Boisteanu D, Whitelaw WA, Cabane J, Garma L, Derenne JPChronic hiccups and sleep. Sleep; 1996;19:227-31, 8723381.

• 3 Howes DHiccups: A new explanation for the mysterious reflex. BioEssays; 2012;34:451-3, 22377831.

• 4 Pooran N, Lee D, Sideridis KProtracted hiccups due to severe erosive esophagitis: a case series. J Clin Gastroenterol; 2006;40:183-5, 16633116.

• 5 Shepherd KL, Holloway RH, Hillman DR, Eastwood PRThe impact of continuous positive airway pressure on the lower esophageal sphincter. Am J Physiol Gastrointest Liver Physiol; 2007;292:G1200-5, 17234890.

• 6 Saitto C, Gristina G, Cosmi EVTreatment of hiccups by continuous positive airway pressure (CPAP) in anesthetized subjects. Anesthesiology; 1982;57:345, 6751158.

Treatment of reflux esophagitis in St. Petersburg: reviews and contacts of clinics

Gastroenterologists of St. Petersburg – latest reviews

He was in the clinic as a medical group for veterans, the gastroenterologist is very competent. Prescribed treatment and necessary tests, only what is needed.It helped me. Would recommend exactly

Anna,

October 31, 2021

Overall, the reception went well enough. The doctor promptly collected an anamnesis, prescribed tests and additional studies. A preliminary diagnosis was made and treatment was prescribed. I will apply again after I have followed all the recommendations of the specialist.

Anonymous,

October 20, 2021

We really liked both the reception and the doctor.Yuliana Gennadievna is a very good, intelligent, kind doctor. The specialist very carefully, corrosively approached our problem. As a result, she prescribed the necessary treatment, which we are now successfully carrying out. If necessary, we will still contact this specialist and recommend her to friends.

Lyudmila,

October 15, 2021

This is not the first time I have applied to this specialist.At the reception, the doctor listened to me, took tests and recommended treatment. After receiving the test results, the treatment will also be additionally adjusted. The doctor is attentive, treats the patient well, knows how to listen, explains everything clearly and easily. I can recommend this specialist to my friends, if necessary. I initially chose this doctor for a convenient location for me. I was pleased with the quality of the reception.

Oksana,

October 13, 2021

An excellent doctor, friendly, listens, draws the right conclusions. Things are good. At the reception, Yulia Evgenievna performed a gastroscopy, told everything, showed it, prescribed tests. Things are good. I spoke like a native. I’m happy with everything. Unpretentious.

Alexander,

October 13, 2021

The doctor examined me, prescribed tests, listened to me, and consulted me.I had a very pleasant impression after the reception. Mikhail Dmitrievich is one of the best doctors I have been to. He was attentive, asked the necessary leading questions. I selected a doctor for myself based on reviews and work experience.

Vladimir,

October 10, 2021

I liked the doctor. Very competent, benevolent, it is clear that he understands his profession, well-mannered, delicate. I explained everything well, all the processes that take place in the body in my part. Everything went well. At the reception, Evgeny Nikolaevich conducted an examination, consultation, and prescribed medications.

Rimma,

September 10, 2021

I liked the doctor.He takes a complex approach to solving the problem from a scientific point of view, does not rely on any one symptom. Asks many questions to understand the cause and how to treat it. He does not follow a ready-made treatment regimen, but tries to figure everything out. Sent for the necessary tests. Gave recommendations for treatment. I was pleased with the reception. I signed up for her again. I liked the clinic. Good service. There is a pharmacy inside, which is very convenient.

Yuliya,

August 18, 2021

An attentive and friendly doctor.She asked everything and wrote that I need to get tested. I was satisfied!

Natalia,

May 25, 2020

A very good attentive doctor, a good specialist in his field, he explains everything very clearly and calmly, there would be more such doctors, I have a very pleasant impression. I am continuing the examination, and according to the results, she will prescribe me a treatment.

Marina,

28 february 2019

Show 10 reviews of 3,158 90,000 Heartburn, belching, gas and tooth decay. How not to miss a dangerous disease | Healthy life | Health

The pace of life of a modern person is such that he has no time for unpleasant physical sensations and incomprehensible pains.It stung there, it burns here, but it seems nothing special. Well, belching after eating, hiccups, tooth decay, unresponsive cough (“ecology is to blame”) – everyone has the same thing, it seems like nothing serious.

Meanwhile, common and seemingly habitual symptoms may indicate a serious illness. “Disease of the century” is what doctors call gastroesophageal reflux disease (GERD). According to medical statistics, GERD is diagnosed in 60-74.5% of adults and 18-25% of children.

“This is a chronic recurrent disease caused by a spontaneous, regularly recurring discharge into the esophagus and then into the pharynx of gastric contents, leading to damage to various parts of the esophagus,” says leading specialist of the Chelyabinsk region, gastroenterologist, pediatrician of the highest qualification category, representative of the Moscow Medical chambers in the Chelyabinsk region under the government of Moscow, a member of the union of pediatricians of Russia Vadim Zemlyakov. – “GERD develops as a result of malfunctions in the disruption of the natural valve – the esophageal and gastric sphincters, which prevent the entry of stomach contents into the esophagus and irritation of the mucous membrane.

Normally, the esophageal valve is triggered in a few seconds when a person swallows, and remains closed for the entire period of food digestion. If the sphincter muscle weakens, then reflux occurs – the return release of part of the eaten. Food mixed with hydrochloric acid, bile entering the esophagus, sooner or later can lead to the appearance of microscopic changes in the mucous membrane (erosions, ulcers), narrowing and even the development of such formidable diseases as cancer. “

Heartburn, belching and hiccups

The most common symptoms of GERD include a burning sensation behind the breastbone, which appears an hour and a half after eating or at night. The discomfort may become more pronounced after intense fitness and overeating. Also, with this disease, there is bitterness in the mouth, bad breath, belching with food – this is the reverse exit of the contents of the stomach, which can be accompanied by a sharp sound and smell of recently eaten food (most often in a horizontal position or when tilting).

Hiccups and heartburn may be signs of GERD. Retrosternal pain may also appear, which radiates to the interscapular region, neck, lower jaw and the left half of the chest.

If the disease is not treated for a long time, then others can be added to the gastric manifestations.

Dental caries, periodontitis, chronic inflammation of the gums, cheilitis (seizures), plaque on the tongue. With this syndrome, the destruction of the enamel of the teeth begins, and they themselves acquire a brown color.

Among the symptoms associated with ENT organs, the following are distinguished: functional dysphonia (loss of voice), sore throat, rough barking, prolonged cough that does not respond to conventional treatment, laryngitis, ulcers, polyps of the vocal cords, inflammation of the middle ear, rhinitis, enlargement adenoids, sensation of a lump in the throat, laryngeal cancer.

Asthma

Finally, the bronchopulmonary syndrome. It requires special attention. It would seem, where are the lungs and where is the stomach, but nevertheless.

“The outstanding English physician William Osler wrote about the relationship between bronchospasm and GERD as early as 1892, who described an attack of suffocation after eating. ” – Explains Vadim Zemlyakov . – “The clinical manifestations of bronchial syndrome in GERD are loss of voice, wheezing noisy breathing, chronic cough, broncho-obstructive syndrome. The most dangerous is the ingestion of hydrochloric acid and pancreatic enzymes into the respiratory tract. This can cause damage to the walls of the bronchi and even pulmonary edema.

Many studies have shown an increase in the risk of bronchial asthma morbidity and the severity of its course in patients with GERD.

“Pathological GER (gastroesophageal reflux), according to various sources, is detected in 30–90% of asthmatics. In some cases, it is reflux that can be the only clinical manifestation of bronchial asthma and cause its ineffective treatment. ” – Continues in adim Leonidovich . – “The likely role of GER in the development of asthma can be indicated by factors such as increased symptoms after eating, lying down, bending over, at night, after taking sleeping pills, as well as the coincidence of cough, wheezing and reflux symptoms. “

Chew and live slowly!

If we talk about the causes of GERD, then they can be considered the consequences of the ordinary life of an ordinary person. We all tend to eat on the run, eat and drink stress, many of us smoke, love soda and chewing gum.

“GERD develops as a result of pressure in the abdominal cavity (for example, with constipation, pregnancy or obesity), from haste when chewing, as a result of which air is actively swallowed, due to the weak tone of the lower esophageal sphincter (the effects of stress),” continues Vadim Countrymen .

– “In addition, the onset of the disease is facilitated by a violation of the ability of the esophagus to self-purify from food particles due to excessive physical exertion, the use of large quantities of drinks containing caffeine (coffee, strong tea, Coca-Cola), a violation of the gastric emptying process, smoking ( nicotine weakens muscle tone), alcohol, which can damage the lining of the esophagus, eating foods rich in animal fats, fried and spicy foods. Carbonated drinks and chewing gum can be unhelpful for those with a predisposition to GERD.

Recommendations of gastroenterologist Zemlyakov for the prevention of GRED in children and adults:

• Infants should be fed in a semi-upright position, and after eating, they should be kept upright for 30-40 minutes. With artificial and mixed feeding, preference is given to antireflux mixtures. When introducing complementary foods, pay attention to its consistency, it should be thick.
• In the crib, give the baby a semi-vertical position, lay the baby on its side after feeding, and he should sleep in a crib with a raised head end. If he sleeps restlessly, is spinning in his sleep, throw pillows over him.
• For older children, fractional meals are recommended up to 5-6 times a day with the exception of mechanical, thermal and chemical irritants (food should not be hot and spicy). Food should be taken slowly, chewing thoroughly. Prevent children from overeating and drinking too much soda. The last dinner should be 3-4 hours before bedtime. “To lie down after eating” is also a bad idea, it is better to sit and walk around.
• It is not recommended to engage in physical exercises associated with bending, tension of the abdominal muscles, lifting weights for 2.5 hours. Watch how tight the belt or waistband is on your child’s clothes. And he should sleep on a bed with a raised head end, which should be 15-20 cm higher than the leg end. Watch the regularity of your child’s stool.
• Everyone else is recommended a certain lifestyle with an appropriate diet: to equalize the weight, give up smoking, hot drinks and alcohol before bedtime, if possible, do not use antidepressants, sedative hypnotics and non-steoroid anti-inflammatory drugs, since they negatively affect the motility and mucous membrane of the esophagus (in any the decision on taking this or that medication should be made by the doctor).
• As far as possible, exclude from the menu foods that reduce the tone of the lower esophageal sphincter: fatty foods, milk, tomatoes and tomato juice, coffee, especially instant coffee; tea, especially with milk, carbonated drinks, fruit compotes and juices, Pepsi-Cola, Coca-Cola, chocolate and other sweets, citrus fruits, bell peppers, spices, all kinds of bitterness, pastry products, alcohol (both spirits, and wines, especially dessert wines), mint, including in chewing gum.

“And don’t forget about the doctors,” adds Vadim Leonidovich . – “If all of the above concerns you to one degree or another, then do not hesitate and make an appointment with narrow specialists: pulmonologists, cardiologists, otorhinolaryngologists and dentists for timely diagnosis and adequate therapy for extraesophageal manifestations of GERD. Well, don’t forget about us gastroenterologists. If reflux is detected in time, then pills can be cured. The neglected course of the disease is fraught with surgery.But if you do not pay attention to the symptoms at all and do not receive treatment, then you can wait for complications up to the appearance of neoplasms. ”

90,000 What are the common causes of chronic hiccups?

Chronic hiccups, which are usually defined as hiccups that last more than 48 hours, can occur from an underlying medical condition, although they sometimes occur for no apparent reason. Conditions such as gastroesophageal reflux, pericarditis, and hiatus hernias can cause chronic hiccups. People who experience chronic hiccups are usually advised to see a doctor to rule out the possibility that a serious medical condition may be the cause. When chronic hiccups occur for no apparent reason, they are usually not considered a cause for medical attention. Chronic hiccups, however, can cause stress and fatigue in those who suffer from them.

Perhaps the most common cause of chronic hiccups is gastroesophageal reflux disease (GERD). GERD can cause acids from the stomach to pass into the esophagus.GERD usually causes other symptoms in addition to hiccups. These additional symptoms may include chest pain, heartburn, trouble swallowing, pain or nausea after eating, and a sour taste in the back of the throat. GERD can permanently damage the esophagus and contribute to the development of esophageal cancer.

Pericarditis, a condition that can cause inflammation of the membrane that surrounds the heart, can also cause persistent hiccups. A number of factors can contribute to pericarditis, including trauma, radiation therapy, viral infection, or heart attack. Additional symptoms may include stabbing chest pains, fever, cough, and fatigue. Serious and even life-threatening complications can occur.

Hiatal hernias, which usually occur in the muscles of the diaphragm, can be another cause of chronic hiccups. Such a hernia can cause the stomach or part of it to enter the chest cavity through the opening in the diaphragm and possibly get stuck there. Additional symptoms may include stomach pain, sour taste in the throat, frequent belching, choking, vomiting, trouble swallowing, and coughing.

A number of other medical conditions can lead to persistent hiccups, including hypoglycemia, diabetes, gastroenteritis, laryngitis, and pharyngitis. Sometimes persistent hiccups occur for no apparent reason and are known as idiopathic chronic hiccups.

Although idiopathic chronic hiccups are not harmful to doctors, they can interrupt sleep, causing fatigue and exhaustion. Patients who are especially concerned about chronic hiccups may be treated. Muscle relaxants can be used to slow down or stop the convulsive movement of the diaphragm that causes hiccups.

Benzodiazepines may be prescribed to some patients, especially those suffering from hiccups, as a complication of an incurable disease. Acupuncture, hypnotherapy, and stimulation of the vagus or phrenic nerves have been used to soothe persistent hiccups. In extreme cases, a phrenic nerve block can stop persistent hiccups, although this procedure often carries dangerous risks.

OTHER LANGUAGES

90,000 Gastroesophageal reflux disease (gerd).Reflux esophagitis symptoms, accurate diagnosis and inexpensive treatment abroad. Polandmed

GERD (Gastroesophageal Reflux Disease) is one of the most common chronic diseases of the digestive system. It occurs as a result of reflux – a regularly repeated throwing of the contents of the stomach or duodenum into the esophagus, as a result of which damage to the esophageal mucosa occurs, and damage to the overlying organs (larynx, pharynx, trachea, bronchi) may also occur.

Gastroesophageal reflux disease – symptoms

The reasons for the onset and aggressive development of GERD disease are:

• weakening of the lower esophageal sphincter
• Decrease in the ability of the esophagus to cleanse itself
• striking qualities of refluctate
• powerlessness of the mucous membrane to resist the negative effects of food thrown into the esophagus
• indigestion stomach
• increased intra-abdominal pressure, after prolonged physical exertion, heavy lifting, excess weight
• narrowing of the esophagus near the lower esophageal sphincter (LES)

Once in the esophagus, the contents of the stomach (food, hydrochloric acid, digestive enzymes) irritate the esophageal mucosa, leading to the development of inflammation.It manifests itself with typical esophageal (esophageal) symptoms: heartburn, sour belching.

Odinophagia – pain when swallowing and during the passage of food through the esophagus. Dysphagia is a feeling of difficulty or obstruction in the passage of food. They occur with the development of complications of GERD – structures (narrowings), tumors of the esophagus. Esophageal hiccups and vomiting are less common. Hiccups are caused by irritation of the phrenic nerve and frequent contraction of the diaphragm. Vomiting is observed when GERD is combined with duodenal ulcer.

Also, in case of herd disease, it is noted: shortness of breath, cough, hoarseness, nausea, bloating and flatulence. After playing sports or lifting weights, you may experience acute pain.

Gastroesophageal reflux disease – treatment

Esophagogastroduodenoscopy. The main diagnostic method for detecting GERD and determining the severity and morphological changes in the wall of the esophagus is esophagogastroduodenoscopy , which is performed after consulting an endoscopist.During this study, a biopsy sample is also taken to study the histological picture of the state of the mucous membrane and diagnose Barrett’s esophagus.

X-ray of the esophagus can reveal an ulcer of the esophagus, the presence of strictures, diaphragmatic hernia. In half of the cases, reflux can be noted. The pressure of the lower esophageal sphincter is determined using manometry.

A characteristic of gastroesophageal reflux disease is a positive Bernstein test (when a 0.1% solution of hydrochloric acid is introduced into the esophagus, a burning sensation appears), as well as a rapid fading of clinical symptoms when taking antacids (alkaline test).The motor function of the esophagus is examined using electromyography .

Often, patients have a cough, hoarseness. An otolaryngologist consultation is required to identify inflammation of the larynx and pharynx. To clarify that the cause of laryngitis and pharyngitis is reflux, antacids are prescribed. After that, the signs of inflammation subside.

Non-drug therapeutic measures in the treatment of disease coat of arms:

• normalization of body weight, adherence to the diet (in small portions every 3-4 hours, eating no later than 3 hours before bedtime), refusal of foods that help relax the esophageal sphincter (fatty fish, chocolate, spices, coffee, oranges , tomato juice, onions, mint, alcoholic drinks), an increase in the amount of animal protein in the diet, refusal of hot food and alcohol;
• it is necessary to avoid tight clothing that squeezes the torso;
• recommended sleeping on a bed with the headboard raised by 15 centimeters;

90,097 smoking cessation;

• it is necessary to avoid prolonged work in an inclined state, heavy physical exertion;
• Medicines that negatively affect esophageal motility (nitrates, anticholinergics, beta-blockers, progesterone, antidepressants, calcium channel blockers), as well as non-steroidal anti-inflammatory drugs that are toxic to the esophageal mucosa are contraindicated.

Drug treatment of gastroesophageal reflux disease is carried out by a gastroenterologist. Therapy takes from 5 to 8 weeks (sometimes the course of treatment reaches 26 weeks), is carried out with the use of the following groups of drugs: antacids (maalox, rennie, phosphalugel, almagel, gastal), H2-histamine blockers (ranitidine, famotidine), proton inhibitors pumps, (omeprazole, rebeprazole, esomeprazole).

In cases where conservative therapy for herd disease does not give an effect (about 5-10% of cases), or when complications or diaphragmatic hernia develop, surgical treatment is performed.Surgical interventions for gastroesophageal reflux disease: endoscopic plication of the gastroesophageal junction (sutures are applied to the cardia), radiofrequency ablation of the esophagus (damage to the muscular layer of the cardia and the gastroesophageal junction, in order to scar and reduce reflux), gastrocardiopexy and laparoscopic fissures.

GERD disease treatment – why choose a clinic in Poland?

If you need treatment for herd disease, Polandmed will take care of organizing high-quality and inexpensive treatment abroad. In addition to paperwork, selection of accommodation, organization of departure and issuance of medical visas, you will be provided with a medical consultant to develop an optimal treatment plan. Such a solution will allow you to stay in a clinic abroad only during consultations and / or treatment, which will save the cost of medical services.

Over the past few years, Polish medical institutions have significantly improved the quality of diagnosis and treatment of diseases, offering the European level at the moment.Clinics and medical centers in Poland are equipped with the most technological equipment, and a number of medical institutions are demonstration centers for medical equipment manufacturers. For the patient, this means access to the latest equipment. Additional advantages of treatment and diagnostics in Poland are the low cost of medical services, the European level of doctors and the absence of a language barrier.

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