a common problem with some unusual causes and cures

Br J Gen Pract. 2016 Nov; 66(652): 584–586.

José Urbano García, MD, PhD

Vascular and Interventional Radiology, Coordinator of the Unit of Vascular and Interventional Radiology, Fundación Jiménez Díaz, Madrid.

Address for correspondence Juan Brañuelas Quiroga, CS Lagasca, Calle Lagasca 122, Madrid, 28006, Spain. E-mail: moc.liamtoh@qbjrd

Received 2016 Mar 16; Revisions requested 2016 Mar 24; Accepted 2016 May 4.

Copyright © British Journal of General Practice 2016This article has been cited by other articles in PMC.

INTRODUCTION

Hiccups is a reflex consisting of a sudden spasmodic contraction of the diaphragm causing shaking of the inspiratory muscles of the chest and abdomen, followed by the sudden closure of the glottis, which generates a characteristic noise of air being violently expelled from the lungs. The hiccup reflex consists of the afferent limb (phrenic nerve, vagus nerve, or thoracic sympathetic fibres), the central connection (not involving a specific centre), and the efferent limb (primarily the phrenic nerve).

Depending on their duration, hiccups are classified as transient hiccups (episodes lasting seconds or minutes), persistent hiccups (longer than 48 hours), and recurrent hiccups (episodes of hiccups more lasting than transient and often with frequent repetition). In most bouts of transient hiccups the aetiology is unknown. In the case of persistent hiccups the most frequent causes are gastro-oesophageal diseases ().¹

Table 1.

Causes of persistent hiccups

This article describes an unusual cause of persistent hiccups and considers some of the remedies that can be used for the condition.

CASE REPORT

A 68-year-old man with a history of smoking (20 pack–years) and a left upper lobe lobectomy for tuberculosis 50 years ago, came to his primary care doctor following about 10 days of persistent hiccups, malaise, and costal and lumbar pain of mild intensity. A blood test was requested and omeprazole 20 mg daily was prescribed.

The patient came back 6 days later to collect the blood test results, with symptoms persisting. The tests revealed slight leucocytosis, C-reactive protein elevation (14.29 mg/dL), erythrocyte sedimentation rate (84 mm/hr), total bilirubin (2.6 mg/dL), direct (0.7 mg/dL), indirect (1.9 mg/dL), and rheumatoid factor (63 UI/ml). He was referred to the emergency department for evaluation.

On admission his general condition was reasonable: lung auscultation revealed decreased breath sounds with scattered crackles. His abdomen was normal, and there was no temporal artery tenderness.

A chest X-ray (CXR) showed mediastinal widening. Thoracic computed tomography angiography was requested, and showed tissue surrounding the aortic wall, with diffuse circumferential swelling caused by an acute thoracic aorta intramural haematoma extending from the left subclavian as far as the renal arteries, with a maximum transverse diameter of 4.7 cm (). The aortopulmonary window was occupied by the aortic haematoma (), and there were two ulcers in the descending thoracic aorta (). No signs of rupture or dissection were seen. A 6.7 cm infra-renal abdominal aortic aneurysm with large intramural thrombus associated with no signs of rupture was also discovered ().

CTA sagittal image of thoracic aorta intramural haematoma (arrows). CTA = computed tomography angiography.

CTA axial image of thoracic aorta with parietal haematoma. (1) Aortic lumen. (2) Image of penetrating aortic ulcer (arrow). CTA = computed tomography angiography.

MPR coronal image: tissue surrounding aortic wall and diffusely circumferential swell that corresponds to the arterial wall haematoma aortic. (2) Aortic lumen. (1) This haematoma extends, partially occupying the aortopulmonary window (arrows). MPR = multiplanar reconstruction.

In order to seal the aortic ulcers and prevent haematoma progression, hybrid surgery (combining open and endovascular approaches) was performed several days after admittance. During surgery a haematoma in the ascending aorta was observed, with a bleeding point at the proximal graft anastomosis, and the defect repaired. However, at 72 hours after surgery, the patient became neurologically unreactive, despite having sedation suspended 36 hours before. A brain CT was reported as showing diffuse brain oedema with signs of tonsillar and bilateral uncal herniation, and intraventricular bleeding. Electroencephalogram (EEG) was reported as characteristic of brain electrical silence.

DISCUSSION

Most hiccup episodes are self-limiting and disappear after a few minutes. Despite being very frequent, they do not have any clinical repercussions, and medical care is not usually requested.

DIAGNOSIS

To target the cause of hiccups, it is very important to take a thorough clinical history, asking about smoking and drug misuse, and drugs, gastrointestinal symptoms (heartburn, dysphagia, regurgitation, or abdominal pain), cardiorespiratory symptoms (chest pain, cough, or dyspnoea), and neurological symptoms (headache, diplopia, dizziness, or abnormal sensitivity). An appropriate physical examination (vital signs, otoscopic, pulmonary and cardiac auscultation, and abdominal and neurological examination) must be conducted. When indicated, additional tests should be requested that are aimed at diagnosis (blood tests, chest X-ray, ECG, gastroscopy, abdominal CT, and cranial MRI) ().¹

Evaluation of persistent hiccups. CT = computed tomography. CXR = chest X-ray. ENT = ear, nose, and throat. LFTs = liver function tests. LP = lumbar puncture. MRI = magnetic resonance imaging. Sx = symptoms.

In the present case, the CXR guided us to the diagnosis and CT was needed to confirm the cause of persistent hiccups: an acute aortic syndrome that caused thoracic aortic enlargement due to an intramural aortic haematoma. This haematoma extended to partially occupy the aortopulmonary window and presumably caused compression of the phrenic nerve that stimulates the diaphragm, which was an initial symptom of the patient with hiccups.

In the differential diagnosis of persistent hiccups, the following questions can help us: does it only happen when awake? Or does it occur day and night? In the first case the hiccups are probably functional and the causes are gastric dilatation, aerophagia, and gastro-oesophageal reflux disease. In the second case it is more likely to be due to toxic–metabolic causes, chronic alcoholism, oesophageal and gastric tumours, pleural involvement, mediastinal or diaphragmatic, or intracranial lesions.² In children, or in an adult in whom all these causes have been excluded, the existence of a foreign body in the ear should be expected.^2,3

COMPLICATIONS

Complications from hiccups are rare but they can occur and include discomfort, difficulty in feeding, gastro-oesophageal reflux, respiratory alkalosis (in tracheostomised patients), wound dehiscence, sleep deprivation, and psychiatric disorders. ⁴

MANAGEMENT

The recommendations for treatment of transient hiccups are nasopharyngeal stimulation (drinking a glass of water, or inserting a tube through the nose as far as the back wall of the pharynx for 20 seconds), vagal stimulation (carotid sinus massage, cold compress to face, or induced vomiting), and respiratory manoeuvres (holding the breath, cough, Valsalva manoeuvre, or breathing into a paper bag). These manoeuvres are, in general, effective only in shortening an attack of acute hiccups and not in the treatment of persistent or recurrent hiccups.

The purpose of these manoeuvres is the attempt to interrupt the reflex arc thought to maintain repetitive diaphragmatic contractions.⁵ This is most often attempted by breath holding, the Valsalva manoeuvre, or breathing into a paper bag. Physiological studies have demonstrated a mechanism by which these manoeuvres improve hiccups, with the frequency of hiccups decreasing as arterial PCO₂ rises. ⁶

In the case of persistent hiccups, the following drugs are used: haloperidol 2–5 mg/24 hr, metoclopramide 10 mg, baclofen⁷ 5 mg/8 hr, phenytoin, valproic acid, carbamazepine, gabapentin, amitriptyline, and amantadine.⁸ Chlorpromazine 25–50 mg intramuscularly or intravenously is effective in up to 80% of cases.

When hiccups fail to respond to the above therapies, other treatment options can be tried, including surgery, hypnosis,⁹ acupuncture,¹⁰ rectal massage,¹¹ sexual stimulation,¹² ejaculation¹³ (possibly as a result of the sympathetic stimulus stemming from ejaculation, which may terminate the reflex arc causing the hiccups), and even smoking marijuana.¹⁴

CONCLUSION

Most hiccup episodes are self-limiting and disappear after a few minutes. Despite being very frequent, they do not have any clinical repercussions, and medical care is not usually requested. But sometimes hiccups are a manifestation of a major disease, as in the case described in this article. Here, the origin of the hiccups was a thoracic aortic enlargement due to an intramural aortic haematoma likely to encourage direct contact with the phrenic nerve, which stimulated the diaphragm. To target the cause of hiccups, it is extremely important to obtain a thorough clinical history.

Acknowledgments

The authors would like to thank the patient’s family.

Notes

Patient consent

The patient’s family consented to the publication of this article and the images.

Provenance

Freely submitted; externally peer reviewed.

Competing interests

The authors have declared no competing interests.

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REFERENCES

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Persistent/Long-Lasting Hiccups

Hiccups occur as a result of the diaphragm suddenly involuntarily contracting. The diaphragm is the layer of muscle that separates the chest and abdominal cavities and plays an important role in controlling breathing. Tightening of the diaphragm causes the vocal cords to suddenly close, which results in the characteristic “hic” sound.

Illustration of diaphragm (yellow) in the body.

Hiccups are very common and affect almost everybody at some point in their lives. Often they occur in the absence of any trigger, although short episodes of hiccups have been linked to a number of causes such as drinking alcohol, eating large quantities of food, drinking fizzy or hot drinks, smoking, eating too quickly and becoming excited, stressed, or scared.

Chronic hiccups

Hiccups generally pass after a few minutes/hours or occasionally, a day or two. In some cases, however, they can last for an extended period of time. Episodes that do not pass within two days and last for up to one month are referred to as “persistent” and in the rare case of them lasting for even longer than one month, they are referred to as “intractable.” The longest episode of hiccups that has even been recorded lasted for 60 years.

Hiccups that recur over long periods are also referred to as “chronic” and depending on how long chronic hiccups last, people may suffer from disrupted sleeping or eating patterns. This can lead to exhaustion, dehydration, and weight loss.

Causes

Nerve damage or irritation

The underlying cause of chronic hiccups is often unknown and the condition is not thought to be inherited, with most cases occurring sporadically in individuals who have no family history of the problem. The most common cause of chronic hiccups is nerve damage or irritation. More specifically, the vagus nerve or phrenic nerve may be affected, which are nerves that serve the diaphragm. Examples of problems that may affect these nerves include the following:

• Laryngitis
• Gastroesophageal reflux
• Growth in the neck such as a tumor or cyst
• A hair touching the eardrum

​Disorders of the central nervous system

A health problem that affects the central nervous system can interfere with the body’s ability to control the hiccup reflex. Some examples of these problems include the following:

• Multiple sclerosis
• Stroke
• Encephalitis
• Meningitis
• Tumor
• Traumatic brain injury

Metabolic disorders

Some examples of metabolic disorders that are associated with the development of chronic hiccups include:

• Diabetes
• Kidney disorders
• Liver abnormality
• Electrolyte imbalance
• Fever
• Uremia
• Hyponatremia
• Hypocalcemia

Drugs

The use of certain drugs is also associated with chronic hiccups and examples include:

• Anesthesia
• Short-acting barbiturates
• Steroids
• Tranquilizers

Other health problems

Further examples of health problems that are associated with chronic hiccups include:

• Those that cause irritation to the diaphragm such as pneumonia, hiatal hernia, pleurisy, and pericarditis
• Gastrointestinal diseases
• Psychological conditions such as hysteria or shock

Diagnosis and treatment

A doctor can usually diagnose a case of chronic hiccups based on symptoms, but a full physical examination may be required, along with a range of blood tests and imaging studies to establish the exact underlying cause. Treatment then depends on the cause and may include the following:

• Muscle relaxants
• Anticonvulsants
• Sedatives
• Analgesics
• Stimulants

In rare cases, medication may not be sufficient to resolve chronic hiccups and surgery may be performed to block the phrenic nerve, which controls the diaphragm.

Further Reading

Hiccups (Hiccoughs). How to stop hiccups. Hiccups causes

What are the symptoms of hiccups?

Everyone has had hiccups, and knows exactly what they are and what they feel like. They affect women and men equally, although persistent hiccups occur much more commonly in men. They happen mainly in the evening.

There is an important difference between short bouts of hiccups and persistent hiccups (lasting longer than 48 hours). Persistent hiccups are more likely to be linked to an underlying illness and you may need medical tests.

What causes short bouts of hiccups?

Most people have bouts of hiccups from time to time. In most cases they start for no apparent reason, last a short while and then stop. Sometimes they are due to:

• Sudden excitement or emotional stress.
• A temporary swollen stomach caused by overeating or eating too fast, drinking fizzy drinks, or swallowing air.
• A sudden change in temperature (very hot or cold food or drinks, a cold shower, etc).
• Alcohol.
• Excess smoking.

What causes persistent hiccups?

Persistent hiccups are rare.

• In some cases, persistent hiccups are caused by an underlying disease. Over 100 diseases have been reported to cause hiccups. Some are common, such as acid reflux, and some are rare. You would normally have other symptoms apart from the hiccups.
• In some cases of persistent hiccups there is no apparent cause. However, the persistent hiccups can become exhausting and distressing.

Examples of conditions which can cause persistent hiccups are:

• Certain medicines – examples are steroids, tranquillisers, painkillers containing opiates (such as morphine) and methyldopa (for blood pressure).
• Changes in blood chemistry such as from alcohol, high blood sugar, or lack of calcium or potassium in the blood.
• Gut problems such as acid reflux, stretching (distension) of the stomach, infection of the gallbladder or infection under the diaphragm.
• A general anaesthetic.
• Conditions affecting the neck, chest or tummy (abdomen). For example, surgery, infections (such as sore throat or pneumonia), swellings or tumours in these parts of the body.
• Some heart conditions – a heart attack or inflammation around the heart.
• Brain conditions such as stroke, head injury or brain infection.
• Hiccups which sometimes occur in the late stages of a terminal illness such as when a person is very ill with advanced cancer.

Do I need any tests?

You are unlikely to need any tests unless you have persistent hiccups lasting more than 48 hours or frequent recurring short bouts of hiccups Unless your doctor can find an obvious cause, they will most likely want to do some tests.

The initial tests are usually blood tests, a heart tracing (electrocardiogram, or ECG) and a chest X-ray. These look for changes such as blood chemistry, chest problems or heart disease.

Other tests may be advised, depending on your individual situation and whether any other medical condition is suspected.

What is the treatment for hiccups?

Short bouts of hiccups

Most cases need no treatment, as a bout of hiccups usually soon goes.

There are many popular remedies that are said to stop a short bout of hiccups but they are based on people’s individual experiences. It is not clear how effective they are, as they have not been tested by research trials. They include the following:

• First, block off all airways by putting fingers in your ears and blocking your nostrils. Then, take a sip or two of water from a glass. It is possible to do this alone (looks a bit silly – but is possible) but you may find it easier with an assistant.
• Sipping iced water.
• Swallowing granulated sugar.
• Biting on a lemon or tasting vinegar.
• Breath holding, breathing fast, or breathing into a paper bag.
• Gasping after a sudden fright, or sneezing.
• Pulling your knees up to your chest and/or leaning forward to compress the chest.
• Using a technique called the Valsalva manoeuvre. (The Valsalva manoeuvre means trying to push your breath out while you hold your throat and voice box closed.) The way to do this is to take a deep breath in, then keep the air inside you while pushing with your muscles as if to force the air out. This is like pushing in childbirth or straining on the toilet.

What is the treatment for persistent hiccups?

If an underlying cause is found then treatment of the underlying cause, if possible, may cure the hiccups. For example, one research study found that many people with persistent hiccups had a gut condition called acid reflux. See separate leaflet called Acid Reflux and Oesophagitis for more details. Treating the reflux seemed to help stop hiccups in many cases. Firstly, try any of the popular remedies used to treat short bouts of hiccups (explained above). Also, treat any underlying cause, if possible.

Secondly, medication is sometimes needed to stop persistent hiccups. Various medicines have been used for this. The following medicines may be used for treating adults with hiccups (for children, specialist advice is recommended):

• Chlorpromazine and haloperidol are medicines which can relax the diaphragm muscle or its nerve supply and may stop persistent hiccups.
• For stomach problems such as acid reflux or a stretched (distended) stomach: anti-acid medicines (various types, such as omeprazole or ranitidine) or medicines which help the stomach to empty faster (such as metoclopramide).
• Baclofen – this is a medicine which helps to relax muscles.
• Gabapentin – this can help to relax the nerve supply to the muscle under your lungs that helps you breathe in (the diaphragm).
• Ketamine – an intravenous anaesthetic – is sometimes effective when other treatments have failed.
• Giving a medication called metoclopramide by intravenous injection has been reported to cure hiccups occurring after anaesthetic.
• For people with a terminal illness, sedatives such as midazolam can help to control hiccups and relieve the stress they cause.

Referral to a specialist is often advised for persistent hiccups, either to look for a cause, or to offer more treatment options. Some examples of treatments that have been successfully used for persistent hiccups are:

• Acupuncture or hypnotherapy.
• A device similar to a pacemaker. This is used to stimulate or pace the nerve to the diaphragm (the phrenic nerve) or to stimulate another important nerve in the neck, called the vagus nerve.

For hiccups that continue despite treatment, a phrenic nerve block is occasionally used. This involves interrupting the phrenic nerve – for example, by injecting a local anaesthetic near the nerve. However, this treatment needs to be considered carefully: it carries risks because the phrenic nerve is important in breathing.

Are there any complications of hiccups?

Short bouts of hiccups do not normally cause any problems or complications.

Persistent hiccups may cause complications such as tiredness, exhaustion or poor sleep. Also, they may cause psychological distress or embarrassment. For people who have had recent surgery to the tummy (abdomen), persistent hiccups may delay healing of the scar (wound), because hiccups move the abdominal muscles. This increases the risk of complications with the wound.

What causes hiccups?

The particular mechanism that provokes the occurrence of hiccups is still unknown. It is also not yet known if hiccups have any specific purpose.

A hiccup involves a unilateral contraction of the left half of the diaphragm, also known as the left hemidiaphragm in roughly 80 percent of reported cases³. However, it is not simply a sudden movement of the diaphram that causes hiccups, but rather a complex motor action within the body.

Medically speaking, it is believed that a hiccup involves a reflex arc (i.e. a neural pathway that is involved in a reflex action) which consists of the following components:

1. An afferent limb (i.e. a neural (nerve) pathway that conducts impulses from the periphery (nerves and ganglia located outside of the brain and spinal cord) to the central nervous system  (which is made up of the brain and spinal cord) – this includes the phrenic and vagus nerves and sympathetic chain. The phrenic nerves (there are two, left and right) originate in the neck and run down between the lung and heart to reach the diaphragm. The vagus nerve is the longest cranial nerve, it runs from the brain down the neck and thorax and to the abdomen. It is comprised of motor and sensory fibers, and can send and receive information to and from the brain. The sympathetic chain is a paired bundle of nerve fibers that extend from the base of the skull to the coccyx.
2. A central mediator (this is thought to include the phrenic nerve nuclei, hypothalamus, respiratory centres and the reticular area of the brainstem).
3. An efferent limb (i.e. a neural pathway that conducts impulses away or outwards from the central nervous system) that includes the phrenic nerve with accessory efferent (outward) nerve connections to the intercostal muscles and glottis.

Whether hiccups play a physiological role in the human body is still unclear, although some experts believe that in utero, hiccups may form a part of programmed exercise to develop the inspiratory muscles necessary for breathing in the unborn baby.

Causes of hiccup bouts

These are the most common form of hiccups and are usually a result of one or more of the below causes:

• Gastric distention – This refers to bloating of the stomach as a result of drinking carbonated beverages and overeating.
• Aerophagia – This refers to swallowing air when eating or chewing gum.
• Sudden changes in gastrointestinal temperature or ambient temperature
• Drinking excessive quantities of alcohol
• Emotional stress or sudden excitement
• Gastric insufflation – This refers to air being blown into the stomach in order to inflate it for a better view during endoscopic procedures.

Persistent and intractable (uncontrollable) hiccups

There is very little known about the prevalence and incidence of persistent, uncontrollable hiccups, however, uncontrollable hiccups may be caused by a severe underlying health condition such as a structural lesion (for example, a tumour or build-up of fluid) or infection of the brain.

The majority of studies conducted on these types of hiccups involve limited case reports. There is no geographic, socioeconomic or racial variation observed in the cases of hiccups documented. However, one study ⁴ involving the review of 220 cases wherein patients suffered intractable hiccups (hiccups that last for longer than one month), found that the majority of the patients (roughly 80 percent) were older men (with an average age of 57 years old). A large number of the patients in this study also suffered from comorbid conditions (i.e. the presence of one or more conditions or diseases occurring simultaneously or one after the other), including 20 percent with vascular disease, 18 percent suffering from postoperative states, 17 percent with central nervous system disease and five percent with duodenal ulcers.

Another case study found that reflux oesophagitis, also known as GERD (gastroesophageal reflux disease) was identified as the most common comorbidity⁵. While other research has shown that persistent or intractable hiccups are experienced by between one and nine percent of patients suffering from advanced cancer⁶.

Chronic hiccups may have significantly adverse effects on the sufferer’s quality of life, leading to insomnia, dehydration, mental stress, weight loss and malnutrition as a result.

Some of the potential causes linked to persistent, as well as intractable hiccups, are described below:

• CNS (central nervous system) disorders –Damage to the vascular (blood vessels including the veins and arteries) and structural portions of the brain and/or spinal cord as well as infections of these, are believed to interfere with the inhibition of the sufferer’s hiccup reflex, simply put, the conditions described below prevent the hiccup reflex from naturally disappearing, resulting in chronic hiccups.                                    

• Vascular lesions – Chronic hiccups as a result of vascular lesions generally occur due to the presence of arteriovenous malformations (AVMs). An AVM is a tangle of poorly formed, abnormal blood vessels connecting the veins and arteries. Arteries carry oxygen-rich blood to the heart and brain, while veins carry deoxygenated blood back to the heart and lungs. AVMs disrupt this important process. They also have a higher bleeding rate in comparison to normal vessels. AVMs may occur anywhere in the body but are most commonly observed in the brain and spine.
• Infectious causes – Infections of the central nervous system (CNS) that can result in chronic hiccups include meningitis (inflammation of the membranes known as meninges surrounding the brain and spinal cord) and encephalitis (inflammation of the brain).
• Structural lesions – These forms of lesions include brainstem tumours and intracranial lesions (areas of injury or disease within the brain), hydrocephalus (this is a disorder also known as ‘water on the brain’ which describes an excessive accumulation of cerebrospinal fluid around the brain and spinal cord), syringomyelia (this is a chronic condition associated with the development of a cyst in the spinal cord) and multiple sclerosis (also known as MS, this is a chronic disorder of the central nervous system wherein the immune system attacks myelin, the protective sheath that covers nerve fibres, and eventually the nerves themselves, causing communication issues between the brain and the rest of the body that results in a host of complications).
• Phrenic and vagus nerve irritation – The phrenic nerve originates in the neck and passes between the heart and lungs to reach the diaphragm. The vagus nerve is the longest cranial nerve and connects the brain to the body. The irritation of these major nerves is often a common cause of chronic hiccups. Some causes of irritation in these nerves include:
  • Laryngitis (inflammation of the voice box), pharyngitis (inflammation of the back of the throat), or tumours in the neck that result in the stimulation of a branch of the vagus nerve known as the laryngeal nerve.
  • Cysts, tumours, goitres (swelling in the neck as a result of an enlarged thyroid gland), diaphragm abnormalities, and mediastinal masses (growths forming in the mediastinum, which is the area of the chest that separates the lungs) may result in the irritation of the phrenic nerve.
  • The auricular branch of the vagus nerve may become irritated by foreign bodies that come into contact with the cone-shaped membrane, known as the tympanic membrane, that separates the external ear and middle ear.

A number of the below disorders may also irritate the phrenic and vagus nerves, leading to hiccups:

• Gastrointestinal disorders – Conditions that affect the intestines and stomach, and may lead to chronic hiccups include:
  • Gastric distention – Bloating of the stomach that occurs when substances such as fluid or air accumulate in the abdomen.
  • Gastritis – This refers to the irritation, inflammation or erosion of the stomach lining which may be the result of a number of different conditions.
  • Gastroesophageal reflux disease (GERD) – Also known as chronic acid reflux, this is a digestive condition that involves bile or stomach acid irritating the lining of the oesophagus.

• Diaphragmatic eventration (protrusion) – This refers to a disorder wherein the diaphragm muscle has an abnormal shape and structure, causing this usually dome shaped structure to be elevated and displaced into the thorax. Diaphragmatic hernia refers to an irregular displacement of the abdominal wall, interfering with the diaphragmatic muscle and resulting in the herniation (i.e. the abnormal protrusion) of the abdominal contents through it.
• Peptic ulcer disease – Wherein a stomach ulcer or sore forms in the abdominal lining.
• Pancreatitis – Inflammation of the pancreas which is often caused by gallstones.
• Pancreatic cancer – Cancer of the pancreas.
• Gastric carcinoma – A type of malignant (cancerous) tumour of the stomach.
• Abdominal abscesses – A collection or pocket of pus and fluid that forms inside the abdominal cavity.
• Gallbladder disease – This encompasses a range is disorders that cause inflammation and irritation of the gallbladder such as cancer, gallstones, and cholestasis (this slows or stops the flow of bile from the liver).
• Inflammatory bowel disease (IBD) – IBD is the term that describes a number of disorders that are linked to the inflammation of the digestive tract.
• Hepatitis – A viral infection resulting in inflammation of the liver.
• Aerophagia – A condition wherein air is swallowed, leading to bloating and excessive belching.
• Oesophageal distention – Distention refers to the state of being enlarged or swollen as a result of internal When the oesophagus becomes distended this may be as a result of inflammation or an infection.
• Oesophagitis – Inflammation or irritation of the oesophagus as a result of infection, medication use, allergies or stomach acid.
• AIDS – Intractable hiccups may also be caused by uncommon complications resulting from AIDS, particularly when these are linked to diseases affecting the oesophagus such as oesophageal candidiasis.

• Thoracic disorders – These conditions include those that are related to the lungs, heart, oesophagus and chest, some of which are mentioned below:
  • Enlargement of the lymph nodes – This occurs as a result of infection or abnormal tissue growth (neoplasm), often caused by Lymph nodes form a vital part of the body’s lymphatic system, which, as part of the immune system, helps to fight off infections.
  • Pneumonia – A lung infection caused by viruses or bacteria that results in the inflammation of the small air sacs (alveoli) of the lungs.
  • Empyema – This condition often occurs secondary to a respiratory infection such as pneumonia and refers to a purulent (i.e. collection of pus) infection in a pleural space. Pleural describes the two membranes surrounding the lungs.
  • Bronchitis – Inflammation of the lining of the bronchial tubes which are responsible for carrying air to and from the lungs.
  • Asthma – This chronic condition affects the airways of the lungs. Asthma results in inflammation of the bronchial tubes which causes them to swell and produce excess mucus, making it difficult to breathe.
  • Pleuritis – Also known as pleurisy, is associated with sharp chest pain when breathing as a result of inflammation of the lining of the lungs, known as the pleura. The most common cause of this condition is a viral infection that spreads to the pleural cavity.
  • Aortic aneurysm – The body’s largest blood vessel is known as the aorta. An aortic aneurysm refers to a bulge or abnormal enlargement of this vessel which is responsible for carrying oxygen-rich blood from the heart to the rest of the body.
  • Mediastinal tumours – These growths form in the part of the chest that separates the lungs from one another (i.e. mid chest or mediastinum).
  • Mediastinitis – This is a life-threatening condition that often occurs as a complication of chest surgery or as a result of a tear in the oesophagus. It has an extremely high mortality rate if it is not timeously diagnosed or treated adequately. It involves the inflammation of the tissues of the chest cavity, also known as the mediastinum, which contains the heart, lymph nodes, thymus gland as well as sections of the aorta, oesophagus, thyroid and parathyroid glands.
  • Chest trauma – A chest injury or trauma is often the result of physical injury or impact to the chest which includes the lungs, heart and ribs. Chest injuries are typically the result of blunt force trauma sustained during motor vehicle accidents or due to a stabbing.
  • Pulmonary embolism – This condition refers to when one or more of the arteries in the lungs becomes blocked as a result of a blood clot, resulting in restricted blood flow, decreased oxygen levels in the blood and fatality. While this is rarely associated with chronic hiccups, it is still considered a possible cause.

• Cardiac disorders – These conditions include a variety of disorders that affect the heart. Cardiac disorders that may cause chronic hiccups include pericarditis, which is the irritation or swelling of the thin, sac-like membrane that surrounds the heart known as the pericardium and myocardial infarction (MI), which is commonly known as a heart attack, and occurs when blood flow to the heart is compromised (i.e. decreased or stopped).
• Toxic-metabolic diseases or drug-related disorders – Toxic-metabolic diseases refer to a collection of conditions that result in chronic or acute CNS (central nervous system) functional disorders. There are a number of factors that can affect the way in which the CNS functions, the use of recreational substances and drugs are among these. Drug-induced states may result in hiccups by affecting the CNS, specifically the vagus or phrenic nerves. Chronic or intractable hiccups may also occur with hyponatremia (a disorder that occurs due to low levels of sodium in the blood) and uraemia (a condition that involves abnormally high amounts of waste products in the blood).
• Postoperative – Chronic hiccups may occur postoperatively, some of the common postoperative causes for hiccups include:
• General anaesthesia (GA) – This refers to the reversible state of unconsciousness that is induced when you receive sedative medications prior to surgical procedures.
• Intubation – Intubation refers to a procedure wherein a flexible plastic tube is inserted through the mouth into the trachea, this allows for the patient to breathe freely during an emergency situation wherein the airway closes or during and/or post-operation. Intubation with glottic stimulation may result in chronic hiccups. The glottis is the natural space that occurs between the vocal folds and the structures surrounding it within the larynx.
• Visceral irritation – The word ‘visceral’ refers to the viscera, which are the internal organs of the body, particularly those found in the chest and abdomen. Visceral irritation or pain is considered a serious medical problem, and describes pain originating from the internal organs. This pain can also stimulate the vagal or phrenic nerves and trigger the hiccup reflex in the brain.
• Drug-related – Certain medications may lead to chronic hiccups, some of these include:
  • Diazepam (Valium) – Part of the benzodiazepine group typically prescribed to induce a calming effect.
  • Barbiturates – Central nervous system depressants that are prescribed as sedatives and sleeping pills, but some are used to induce sedation and anaesthesia.
  • Dexamethasone – A type of corticosteroid medication used in the treatment of a variety of inflammatory conditions.
  • Certain chemotherapeutic agents – Some patients receiving chemotherapy medications for the treatment of cancer may suffer from chronic hiccups as a result. Examples of these drugs include – Oxaliplatin, 5-fluorouracil, leucovorin⁷.
  • Alpha-methyldopa – Medication used to treat high blood pressure

• Psychogenic factors – There are some psychogenic factors (i.e. of a psychological origin as opposed to a physical one) that are associated with chronic hiccups. Psychogenic causes will, however, only be taken into consideration after a thorough medical examination has been conducted. Some of these conditions include:
  • Anxiety – An uncomfortable feeling of worry or nervousness
  • Stress – A state of tension or mental strain
  • Excitement – Feeling great eagerness or enthusiasm
  • Malingering – To exaggerate or pretend to be sick or incapable

^References:

^{3. NCBI. 1952. Hiccup; a ten-year review of anatomy, etiology, and treatment. Available: https://www.ncbi.nlm.nih.gov/pubmed?term=13009550 [Accessed 08. 02. 2017]}

^{4. NCBI. 1968. Intractable hiccup. Etiologic factors in 220 cases. Available: https://www.ncbi.nlm.nih.gov/pubmed?term=5638775 [Accessed 08. 02. 2017]}

^{5. NCBI. 1992. Chronic hiccups. Available: https://www.ncbi.nlm.nih.gov/pubmed?term=1344930 [Accessed 08. 02. 2017]}

^{6. NCBI. 2012. Treatment of chronic hiccups in cancer patients: a systematic review. Available: https://www.ncbi.nlm.nih.gov/pubmed?term=22891647 [Accessed 08. 02. 2017]}

^{7. NCBI. 2009. Severe hiccups during chemotherapy: corticosteroids the likely culprit. Available: https://www.ncbi.nlm.nih.gov/pubmed/19276142 [Accessed 27. 02. 2017]}

What causes hiccups? – Scientific American

William A. Whitelaw, a professor in the department of medicine at the University of Calgary, explains.

If a person gets hiccups and wants to know what has set them off, there is a long list of medical or physiological disorders that are associated with hiccups and seem to cause them. The most common by far is distension or expansion of the stomach and movement of stomach acid into the esophagus. After that, a disease or irritation in the thorax could be to blame. Irritation of the phrenic nerve (the nerve to the diaphragm) or the diaphragm is often cited as a cause of hiccups, but this is only speculation about the exact mechanism. Hiccups can also arise from a variety of neurological lesions, many of them involving the brain stem, or some metabolic disorders (particularly renal failure). Medications, often ones that promote acid reflux into the esophagus, and a variety of other disorders have also been linked to hiccups.

In medical practice, however, we do not start looking for any of these causes unless the hiccups are very persistent or if they came on very dramatically for no obvious reason. For ordinary bothersome hiccups that come back or stay longer than usual, treatment for stomach acid reflux is usually offered before other investigations are done.

In regards to the physiological process behind hiccuping, some information and speculations exist, but a complete answer has not yet been determined. A hiccup is not simply a twitch of the diaphragm but a complex motor act. During one, the diaphragm and the complete set of inspiratory muscles (intercostal muscles, neck muscles and others) make a sudden, very strong, contraction. The expiratory muscles are also strongly inhibited. Just after the contraction begins, the glottis (commonly called the vocal cords) clamp shut, making the “hic” sound. Before the diaphragm contracts, the roof of the mouth moves up, as does the back of the tongue, and there is often an associated burp. The heart slows a bit as well. In addition, hiccups are seldom isolated events but tend to recur every few seconds, sometimes for hours.

Together these observations imply that somewhere in the brain we have a “central pattern generator,” or CPG, for hiccups. In other words, there is a neuronal circuit designed for generating hiccups similar to the ones we have for actions such as breathing, coughing and walking. And like most of those CPGs, it is an oscillator: it sends out a recurring, periodic signal to set off a hiccup. We don’t have hiccups all the time, however, so the oscillator must be a “conditional oscillator” that fires only under certain conditions.

Hiccups are seen in a wide variety of animals and are very common in the fetus. They have been recorded physiologically in animal studies and are easily recognized on ultrasounds of human babies. Hiccups appear before breathing movements as the fetus develops and are common in newborns but gradually disappear over the next few months.

These observations suggest that hiccup CPG may be left over from a previous stage in evolution. Searching through the animal kingdom for a recurring, rhythmic activity that resembles a hiccup turns up a few candidates. None of them looks exactly like a hiccup, but that is not really surprising given all the changes that have occurred over the eons. One candidate is the CPG for gasping, which is a sudden inspiration and can be rhythmic. In a recent paper, my colleagues and I argued that a better candidate is the CPG used by tadpoles for gill ventilation. The unique feature of hiccups is a big inspiratory effort while closing the glottis, which completely blocks air from being inspired. Halfway through its development a tadpole has both lungs that breathe air and gills for breathing water. It does not have a diaphragm and cannot suck air into its lungs and instead pushes fluids with its mouth. To breathe air, it fills its mouth cavity with air, then closes its nose, mouth and the passage to the gills and compresses the mouth cavity, forcing the air into its lungs. To breathe water, it fills its mouth with water and then closes the glottis and forces the water out through the gills. The positive pressure pump action of the mouth is synchronous with filling the lung or pushing water through the gills. The gill-breathing tadpole is thus inspiring while closing the glottis, the same action as hiccuping.

Answer originally posted May 3, 2004.

Are My Hiccups Chronic? | Banner Health

All a minor inconvenience needs to become major is time. That rock in your shoe is bothersome at first. But after 5 miles, you’ll be walking with a limp. The same can be said for hiccups. A sudden bout of hiccups during a first-date conversation can kill the vibe. But “chronic” hiccups can be a life-changing issue.

Cases of chronic hiccups are extremely rare and can have many causes. In order to better understand the science behind hiccups, we spoke with Lloyd Perino, MD, a gastroenterologist at Banner Health Clinic in Arizona.

What is a hiccup?

“Your hiccups are a result of spasms causing your diaphragm to contract involuntarily,” said Dr. Perino. “The phrenic nerve controls much of your diaphragm’s motion, which is the primary muscle in charge of your breathing.”

“In almost every case, your hiccups are caused by a benign, insignificant reaction in your body. They may create some social stress or make it hard to fall asleep, but that’s the extent.” In some rare cases, your hiccups may be caused by food allergies, tympanic membrane (eardrum) irritation or a tumor near the phrenic nerve. But these are not the norm.

What are Chronic Hiccups?

While a typical bout of hiccups will come and go in a matter of minutes, chronic hiccups can stay with people for days or even weeks. The cause of the condition can vary from person to person. Dr Perino noted that he sees maybe one case per year of hiccups lasting 24 hours or more. He said, “it’s uncommon that these hiccups are a sign of anything concerning, but I recommend a CT scan of the chest to look for anything that might affect the phrenic nerve.”

A few hiccups here and there aren’t dangerous, we’ve all had them. But in chronic cases, they can cause direct and indirect damage over time. For example:

How are Chronic Hiccups Treated?

The cause behind chronic hiccups varies greatly from person to person. It’s a very rare condition that could be associated with other serious issues such as gastrointestinal diseases, liver abnormalities, brain or psychological concerns, metabolic disorders or many others. The exact underlying cause could be none of these issues, something totally different or several of the issues at once. Regardless, you and your doctor will work to find a treatment that is centered around the underlying cause, while softening symptoms to make you more comfortable. In many cases, prescribed medication can ease the burden of the hiccups while you investigate for any deeper issues.

Tips to Get Rid of Non-Chronic Hiccups

For most of the world, chronic hiccups won’t ever be a problem. We asked Dr. Perino to offer his perspective on familiar home remedies for a common case of hiccups. “It’s fair to try any home remedy,” Dr. Perino replied. “Although, I’ve never found holding one’s breath to be especially successful, nor have I found scaring someone to be a reliable cure. For some, I’ve recommended 10 small gulps of fluid between hiccups. This can help if the hiccups are esophageal related.”

If you are experiencing painful or persistent bouts of hiccups lasting up to 24 hours, schedule a visit with a Banner Health expert.

Join the Conversation

Hiccups | healthdirect

On this page

What are hiccups?

Hiccups, also known as hiccoughs, are caused by a spasm of the diaphragm. The diaphragm is the thin muscle between the chest and abdomen. If it suddenly and involuntarily contracts or tightens, it causes a sharp intake of breath. When this happens, you quickly close your vocal cords, which produces the ‘hiccup’ sound.

Hiccups can be annoying but are not usually serious and typically go away after a while. If hiccups go on for longer than 2 days, they are considered ‘persistent’ or long-lasting, and can interfere with eating and sleeping.

See your doctor if your hiccups last for more than 2 days, if you have trouble breathing or swallowing, or if you have a severe pain in the abdomen (belly).

What causes hiccups?

Hiccups may start and stop without any obvious reason. However, some things increase your chances of having hiccups including:

• overeating, or eating too quickly
• spicy foods
• hot or fizzy drinks
• alcohol
• smoking
• stress, fear or excitement
• swallowing air

In rare cases, hiccups that last for days or weeks may be caused by an underlying condition, or by some medications.

Some of the underlying conditions are:

Medications that have been associated with hiccups include:

Long-lasting hiccups can cause discomfort and pain, disrupt sleeping and eating, and may cause anxiety or depression.

Hiccups in babies

Babies often have hiccups. They can even have hiccups in the womb.

Hiccups do not normally bother babies. But if you want to stop your baby hiccupping, you can:

• take a break from feeding to burp them
• give them a dummy to suck
• rub their back
• sit them upright after their feed

If you are worried about your baby’s hiccups, speak to your doctor or child health nurse.

How to get rid of hiccups

In most cases, an episode of hiccups will stop all on its own after a few minutes. You can try the following, although none of these have been proven to stop hiccups:

• holding your breath for a short period
• sipping cold water
• breathing into a paper bag

Other unproven remedies including biting on a lemon and getting a fright.

If your hiccups last longer than 2 days, see your doctor. If an underlying condition is causing your hiccups, treating that condition may help.

A number of medications, and also acupuncture treatments, have been used to treat long-lasting hiccups. However, it is not clear how well these treatments work.

90,000 causes of occurrence, under what diseases occurs, diagnostics and methods of treatment

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-medication. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For a diagnosis and correct treatment, you should contact your doctor.

According to the International Classification of Diseases, hiccups are dealt with in the Abnormal Breathing section.In the mechanism of this involuntary physiological reaction, the diaphragm and intercostal muscles are involved, which, contracting convulsively, initiate a short breath, and the sudden closure of the airways by the epiglottis is accompanied by a characteristic sound.

Varieties

If the duration of hiccups does not exceed 10-15 minutes, it is called short-term, or episodic. Sometimes hiccups last longer – up to two days, and then it is called persistent. Finally, an uncoupled one is possible, i.e.e. intractable persistent hiccups that lasts for two or more months. Only persistent or intractable hiccups is a reason to see a doctor, as it can be a symptom of diseases or injuries that cause convulsive contractions of the diaphragm. The function of the diaphragm is subordinated to the work of the nervous structures of the brain located in the medulla oblongata and hypothalamus. The diaphragm is innervated by two (right and left) phrenic nerves that originate in the neck (segments CIII – CIV).The cause of persistent and intractable hiccups is pathologies leading to damage to the structures of the reflex arc. Depending on the level of the lesion, central and peripheral hiccups are distinguished. Hiccups of central origin occurs with damage to the brain and / or spinal cord, peripheral – with damage to the phrenic nerve, which can occur as a result of diseases of the gastrointestinal tract and the cardiovascular system. There is another type of damage – toxic, which is caused by the effects of alcohol, nicotine, toxic metabolic products and drugs on the nerve endings.

Possible causes of hiccups

In adults, short hiccups serve as an evolutionarily developed mechanism aimed at displacing air from the stomach. The ingress of excess air into the stomach can be caused by improper and fast food intake, laughter, during which a series of sharp breaths occur. In addition, irritation of the vagus nerve, leading to hiccups, can be triggered by stomach overflow, hasty dry food, hypothermia. In young children, hiccups often occur as a result of air entering the stomach during feeding, as well as distension of the stomach due to overfeeding.If the hiccups stop after a few minutes, they don’t need much attention. However, with prolonged hiccups, a doctor’s consultation is necessary.

Prolonged intractable hiccups of central origin can occur with stroke of the brain in older people or in patients with vascular diseases, systemic lupus erythematosus. In addition, prolonged hiccups can be a symptom of a brain tumor and its trunk. Cerebellar artery aneurysm can also lead to hiccups.Hiccups may indicate brain injury , accompanied by the formation of a hematoma.

Hiccups caused by irritation of peripheral nerves are a symptom of diseases such as hiatus hernia large (> 3 cm), neoplasms of the esophagus, pancreas and stomach . Persistent hiccups can be observed with pathologies of the cardiovascular system: myocardial infarction , heart rhythm disturbances, i.e.because they increase the excitability of the endings of the vagus nerve. Respiratory diseases, in particular laryngitis, bronchitis and pneumonia , as well as mediastinal tumors can cause hiccups due to irritation of the phrenic nerve. There is evidence of persistent hiccups in patients with herpes . In these cases, the pathological process starts the herpes virus, which multiplies in the nerve ganglia. The cause of hiccups can also be compression of the spinal root of the fourth cervical vertebra by hernia, as well as a tumor of the neck.Other factors causing prolonged hiccups include autoimmune diseases (neuromyelitis optic, multiple sclerosis), epilepsy , encephalitis, meningitis, Parkinson’s disease .

Toxic hiccups occur when metabolic disorders due to nerve damage to toxins that accumulate in the blood. Such hiccups can occur with diabetic neuropathy in diabetes mellitus, intoxication with uremia (the last stage kidney disease ), electrolyte imbalance in hypocalcemia ( diseases of the parathyroid and thyroid glands ) and hypokalemia (Cushing’s syndrome, vomiting, diarrhea, etc.).d. ). Toxic hiccups can develop with taking medications: antiparkinsonian drugs, drugs used in psychiatry, azithromycin (antibiotic), morphine. Chemotherapy drugs , used in the treatment of cancer patients, as well as drugs , administered under anesthesia , with epidural anesthesia, can also cause prolonged hiccups.

Diagnostics and examinations

The diagnostic algorithm for prolonged hiccups sometimes involves a complete examination of the patient to identify the cause of this pathological condition.The doctor conducts a thorough survey of the patient, specifies the names of the drugs taken by the patient, and evaluates the neurological status.

First of all, it is necessary to exclude cerebral stroke and myocardial infarction. For this, a consultation with a neurologist and a cardiologist is prescribed, as well as an MRI of the brain, an electrocardiogram, clinical and biochemical blood tests.

How to beat hiccups? – BBC News Russian service

• Claudia Hammond
• BBC Future

November 4, 2014

Photo author, Thinkstock

Photo caption,

Sticking out your tongue as much as possible – this also often helps

Holding your breath or try some more exotic and crude way? Correspondent

BBC Future talks about how to stop hiccups on your own and why these methods work.

As soon as someone starts to hiccup, everyone starts to scare the unfortunate person, offer him to hold his breath and give a lot of other advice. What are the ways to beat hiccups supported by scientific evidence?

Hiccups are a consequence of diaphragm spasm, causing air to flow into the lungs, which, in turn, causes a sharp closure of the vocal cords with a characteristic hiccup sound. There are more than a hundred reasons for hiccups – in most cases, quite harmless. For example, it can be medication-related – some anesthetics and steroids, drugs prescribed for Parkinson’s disease, and chemotherapy drugs used to treat cancer can provoke hiccups.But, as a rule, this is not the case. Laughter, alcohol abuse, or hastily swallowing food or soda can also lead to hiccups – and sometimes it even occurs on its own, without any reason.

It doesn’t do without extremes. It is believed that the world record for the duration of hiccups belongs to an American named Charles Osborne: an attack of hiccups began in 1922 (according to available data, at that moment he was trying to weigh a pig), and stopped only 68 years later – in February 1990.

Fortunately, hiccups can usually be stopped using simpler methods – however, the debate over which one is the most effective is still ongoing.

The bulk of folk remedies affect one of two mechanisms. The first group includes methods aimed at increasing the level of carbon dioxide in the blood, which is designed to weaken the spasm of the diaphragm, for example, holding your breath or breathing through a paper bag.

Sometimes these methods are effective, but scientists still do not really understand what their effect is.Some believe that this allows you to switch attention to the problem of increasing the concentration of carbon dioxide, while others suggest that it is the lack of this gas that is one of the causes of hiccups, therefore, its replenishment allows you to stop the attack.

Nervous IR

An alternative way to combat hiccups is to stimulate the vagus nerve, which connects the head to the abdominal region and is responsible for coordinating breathing and swallowing. This nerve is involved in the hiccuping process, which can be interrupted by a certain action on the nerve, as a result of which it begins to send signals to the brain about the appearance of a new sensation.

This group includes tips for drinking water, chewing lemon or putting crushed ice in your mouth. To stimulate the vagus nerve, you can also stick your tongue out, insert your fingers into your ears, or apply light pressure to your eyeballs. In essence, this is an attempt to distract the body from the hiccups by switching attention to some unexpected event. Attempts to stop the hiccups by scaring the sufferer are based on the same logic.

Author of the photo, Thinkstock

Caption,

There are also such radical means of fighting hiccups that are not suitable for use at home.Or is it just the opposite?

There is one more radical remedy, which, perhaps, is not suitable for use at home. It was introduced by Francis Fesmire, a professor at the University of Tennessee School of Medicine (USA). The essence of the method is clear from the title of his scientific work, published in 1988, – “Termination of intractable hiccups by massage of the rectum.”

It all started when a man came to the emergency room with a complaint of hiccups, which lasted for three days with an interval of two seconds.The doctor forced the patient to open his mouth wide, pressed on his eyeballs, but nothing helped. After trying all the remedies, Fesmire remembered the material he read last year about how the doctor managed to stop the accelerated heartbeat in a 71-year-old woman by inserting a finger into her anus. This remedy also helped the hiccuping patient.

However, having received a parody Shnobel Prize for his discovery, Fesmire stated that the same effect, most likely, can be achieved through orgasm, and most patients would probably prefer this method.Both of these approaches also aim to stimulate the vagus nerve.

Most of the folk remedies for getting rid of hiccups do not really have scientific evidence. However, the mechanisms on which they are based are consistent with our knowledge of her physiology; moreover, all of these methods are considered harmless. None of them are universal, which is why they are so numerous, but all of them are not just idle fiction. Start to hiccup – feel free to try any of them.

Limitation of Liability. All information contained in this article is for general information only and should not be considered as an alternative to the advice of your healthcare professional or other healthcare professional. The BBC is not responsible for the information posted on external sites linked to in this article and does not endorse any commercial products or services mentioned or recommended on any of these sites. If you have any health problems, contact your physician immediately.

Hiccups – causes, examination and treatment in Astrakhan | Symptoms

Gastroesophageal reflux disease
Signs: Heartburn (burning pain starting in the upper abdomen and going up to the throat, sometimes with a sour taste in the mouth). Chest pain, sometimes coughing, hoarseness. Symptoms sometimes begin while lying down. Relief when taking antacids.

Recent abdominal surgery
Signs: History of obvious recent surgery.

Gallbladder disease
Signs: Pain in the upper right side of the abdomen, under the ribs. Sometimes nausea and vomiting.

Hepatitis
Signs: General malaise, decreased appetite, nausea and sometimes vomiting. Sometimes darkening of the urine, followed by yellowing of the skin and whites of the eyes (jaundice). Feeling of slight discomfort in the upper right side of the abdominal cavity.

Liver cancer (including malignant tumors metastasized to the liver)
Signs: Prolonged upper abdominal discomfort, weight loss, fatigue.

Pancreatitis
Signs: Severe, persistent upper abdominal pain, usually vomiting.

Pregnancy
Signs: Usually a missed menstrual cycle. Sometimes morning sickness and / or breast swelling.

Recent chest surgery
Signs: History of obvious recent surgery.

Pericarditis (inflammation of the membrane around the heart)
Signs: Sharp chest pain, aggravated by breathing and coughing.

Diaphragmatic pleurisy (inflammation of the part of the membrane around the lungs (pleura)
Signs: Sharp chest pain, aggravated by breathing and coughing.

Pneumonia
Signs: Cough, fever, chills and chest pain, sometimes shortness of breath.

Alcoholism
Signs: History of alcohol abuse.

Certain brain tumors or strokes
Signs: Sometimes in people who have had a stroke or who have a tumor.Sometimes recurrent headaches and / or difficulty walking, speaking, expressing thoughts, or seeing.

Renal failure
Signs: Usually in people with kidney failure.

SCIENTISTS HAVE PROVEN WHY IT IS USEFUL

Clarifies that this is spontaneous hiccups and not caused by overeating

Newborn hiccups are an important element of brain development and the earliest established physiological process that continues after birth.This conclusion was made by scientists from University College London. A study published in the journal Clinical Neurophysiology says that contractions of the diaphragm muscles due to hiccups cause a pronounced response in the cerebral cortex of newborn babies.

Scientists came to this conclusion on the basis of brain scans of newborns, both full-term and premature, with a gestational age (measured from the day of conception) from 30 to 42 weeks (corresponds to the last trimester of pregnancy).

Hiccups begin in the womb from the 9th week of pregnancy. Premature babies are especially prone to hiccups; on average, they can hiccup up to 15 minutes a day.

So, each “IK” generated in the brain of babies two large neural waves associated with the contraction of the diaphragm, and then a third followed, similar in type to the wave caused by sound effects. Presumably, it was at this moment that the sound of hiccups was associated in the infant’s brain with the movement of the diaphragm.

Presumably, this is how the child begins to feel the inner body, and his brain learns to control the diaphragm, which is an important skill for regulating breathing.

“Activities caused by hiccups can help a child’s brain learn to control the breathing muscles so that breathing can eventually be controlled by moving the diaphragm up and down. When we are born, the neural circuits that process the sensations of the body are not fully developed, so the creation of such networks is an important milestone in the development of newborns, ”said study leader Dr. Lorenzo Fabrizi of University College London.

Scientists have suggested that when children push in the womb, mental maps of their own bodies are created in their brains. Now scientists say that similar mechanisms work for the internal processes of the body.

“Our results prompted us to wonder if hiccups in adults might actually be a rudimentary reflex left over from infancy,” notes the first author of the article, clarifying that we are talking about spontaneous hiccups, and not about the one that occurs as a result of overeating.

Photo from open sources.

90,000 signs of the disease, varieties, diagnostic methods

Hiccups are a physiological reaction that occurs when nerve endings are irritated. When a person hiccups, the diaphragm and muscles between the ribs contract convulsively, resulting in a short breath. The sound produced by hiccups is due to the airway being blocked by the epiglottis.

Varieties of hiccups and reasons for the appearance

Almost every person has encountered a short hiccup. It lasts no more than 15 minutes, after which the condition returns to normal. Such hiccups are called episodic. It does not pose a threat to health. Prolonged hiccups are called persistent. It can last up to two days. A more severe variety is persistent hiccups, also known as toxic hiccups. It lasts two months or more. A similar condition is pathological and arises as a result of convulsions of the diaphragm, due to which it involuntarily contracts.The reason for this phenomenon can be various diseases of the gastrointestinal tract and the cardiovascular system, intoxication caused by the abuse of alcohol or drugs.

Why hiccups appear

Adults and children are prone to hiccups. A person begins to hiccup when excess air enters the stomach. This is influenced by several factors:

• haste when eating;
• dry food;
• exposure to low temperatures;
• strong laughter.

In young children, hiccups can develop from overfeeding, which can stretch the stomach.

Short-term hiccups are an evolutionary mechanism that removes excess air from the stomach. If a person hiccups for several days in a row, you need to see a doctor. Long-term hiccups are a nonspecific symptom of a number of serious illnesses:

• heart attack, stroke;
• brain tumors;

90,248 aneurysms;

• tumors of the esophagus, stomach, pancreas;
• meningitis;
• encephalitis;
• multiple sclerosis;
• kidney diseases.

Patients with such pathologies require long-term complex treatment.

Diagnostics

With prolonged hiccups, the patient needs a comprehensive examination. It includes:

• Laboratory analyzes.
• ECG.
• MRI of the brain.

In case of toxic hiccups, it is necessary first of all to consult a neurologist and a cardiologist in order to exclude a possible heart attack or stroke.

Pay attention!

The information presented on the site should not be used for self-diagnosis and treatment and cannot serve as a substitute for an in-person consultation with a doctor.
90,000 Causes of hiccups, frequent yawning, sneezing: body language

The causes of hiccups, sneezing and yawning are quite serious. Therefore, if you are used to drinking water in small sips during hiccups, without thinking about what hiccups mean, it’s time to pay attention to the signals that the body gives.

Hiccups: reasons

Hiccups in adults are caused by drinking alcohol or eating a large portion of food, especially if it was consumed very quickly. The causes of hiccups in newborns are overeating, and also hiccups in children have other reasons, namely, the baby’s desire to drink or if he is cold.

Frequent hiccups: reasons

Hiccups, the causes of which are overeating, has the following mechanism of occurrence. So, poorly chewing large pieces of food while quickly absorbing food, a person provokes irritation of the vagus nerve – one of the cranial nerves that runs along the pharynx and esophagus from the brain to the diaphragm and stomach.When large pieces of food pass through the esophagus, they irritate the vagus nerve, and it sends signals to the muscle fibers of the stomach and esophagus, causing spasms – hiccups.

These spasms try to get rid of the swelling of the esophageal mucosa.

Hiccups: How to Get Rid of?

If hiccups appear after drinking alcohol, drinking cold water in small sips will help get rid of it. Holding your breath helps with hiccups caused by overeating. In addition, you can try other methods: eat a teaspoon of sugar without drinking water or hold a lemon wedge in your mouth for several minutes.

Sneezing: Causes

Frequent sneezing caused by the accumulation of dust in the nasal cavity helps to get rid of all excess from the nose so that “debris” does not get into the nasopharynx. The norm is 2-3 sneezes in a row.

Frequent sneezing, the reasons for which are explained above, if it happens more than 10 times in a row, most likely signals the presence of edema on the nasal mucosa. For the body, edema is an irritant that it tries to “sneeze out”, but the edema does not go away from this. In this case, you can try to drip vasoconstrictor drops into the nose, with the help of which the swelling will be eliminated.

Yawning: reasons

Frequent yawning is caused by hypoxia, when the brain lacks oxygen. Therefore, a person needs a deep and strong breath, because when yawning, much more air is inhaled than when inhaling normally. This is due to the fact that the airways are opened and a large amount of oxygen quickly enters the blood.

In addition, yawning occurs when severe fatigue and lack of sleep. From fatigue, excess carbon dioxide accumulates in the tissues, which is the same hypoxia.

Also, people often yawn when they feel bored, when it is necessary to do something that they do not want, which is explained by the fact that working through “don’t want” causes much more fatigue.

Cough

Cough is a frequent companion of colds, but quite often it occurs without this ailment. What are its causes and what does the body want to say with a cough? A cough may indicate gastroesophageal reflux disease (gastric acids entering the esophagus). Cough in this case usually appears during sleep, it is often accompanied by a sour taste in the mouth, heartburn.Allergies, smoking, exposure to dust, bronchospasm can also cause coughing.

When coughing without a cold, it is better to quit smoking and it is imperative to humidify the air in the room.

Also, gargling with salt water (half a teaspoon of salt in a glass of warm water) will not be superfluous.

90,000 Scientists report the benefits of hiccups for children’s brains

In a new study, researchers reported the results of brain scans of babies with hiccups.

Scientists from University College London conducted a neurophysiological study of hiccups in newborns

Babies are more prone to hiccups – they hiccup at least 1% of the time. Scientists have long found that a child begins to hiccup as early as the ninth week of pregnancy. The hypothesis of the new study was that hiccups have the function of activating the respiratory system and its brain centers.

The researchers examined 13 babies suffering from hiccups, between the ages of 30 and 42 gestational weeks.They underwent an EEG brain scan. Contractions of the diaphragm muscles during hiccups elicited a response in the cerebral cortex. Researchers believe that the baby’s brain connects the sound of hiccups and the sensation of contraction of the diaphragm muscles, which is important for the development of brain connections.

According to scientists, the activity caused by hiccups can help the child learn to control the respiratory muscles, so that in the end it is possible to arbitrarily control breathing, writes Naked science.

Despite the fact that we live in the 21st century, there are still some outdated ideas about the fragility of children’s health still strong in society.Although, it would seem, from almost every iron, doctors shout that this opinion is wrong. The number of citizens who accept myths at face value is not decreasing.

We have prepared the five most common misconceptions of parents, the falsity of which has long been proven by official medicine.

One of the main causes of obesity in children was previously named.

Infants who are bottle-fed or only occasionally breastfed are at greater risk of obesity.