Why do hiccups occur. What are the common triggers for hiccups. How can persistent hiccups be treated. When should you seek medical attention for hiccups. What home remedies can help stop hiccups. Are hiccups a sign of an underlying condition. How long do hiccups typically last.

The Science Behind Hiccups: What Causes These Involuntary Spasms?

Hiccups are involuntary contractions of the diaphragm, the muscular sheet that separates the chest cavity from the abdomen. These contractions cause a sudden intake of breath, which is then abruptly stopped by the closure of the vocal cords. This rapid closure produces the characteristic “hic” sound we associate with hiccups.

The exact mechanism that triggers hiccups remains somewhat of a mystery to medical science. However, researchers have identified several factors that can contribute to their onset:

• Irritation of the phrenic nerve, which controls the diaphragm
• Sudden changes in stomach distension
• Rapid eating or drinking
• Swallowing air while eating or drinking
• Carbonated beverages
• Sudden temperature changes in the stomach

Hiccups typically resolve on their own within a few minutes to a few hours. However, in rare cases, they can persist for days, weeks, or even months, which may indicate an underlying medical condition.

Common Triggers: What Everyday Factors Can Cause Hiccups?

While the exact cause of hiccups isn’t always clear, certain factors are known to increase the likelihood of experiencing them. Understanding these triggers can help you avoid or minimize hiccup episodes:

• Eating too quickly or consuming large meals
• Drinking carbonated beverages
• Consuming hot or spicy foods
• Swallowing air while chewing gum or smoking
• Sudden changes in temperature (e.g., drinking very hot or cold beverages)
• Stress or excitement
• Certain medications

Do certain foods or drinks consistently trigger your hiccups? Keeping a food diary can help you identify personal triggers and avoid them in the future.

The Duration Dilemma: How Long Do Hiccups Typically Last?

The duration of hiccups can vary widely from person to person and episode to episode. Generally, hiccups fall into three categories based on their duration:

1. Acute hiccups: Lasting up to 48 hours
2. Persistent hiccups: Lasting from 48 hours to 1 month
3. Intractable hiccups: Lasting longer than 1 month

Most hiccup episodes are acute, resolving within a few minutes to a few hours. Persistent and intractable hiccups are much rarer and often indicate an underlying medical condition that requires professional attention.

Is there a way to predict how long a hiccup episode will last? Unfortunately, there’s no reliable method to determine the duration of hiccups in advance. However, if your hiccups persist for more than 48 hours, it’s advisable to consult a healthcare provider.

Home Remedies: Effective Techniques to Stop Hiccups

While hiccups often resolve on their own, various home remedies can help alleviate them more quickly. Here are some popular and potentially effective techniques:

• Hold your breath for 10-15 seconds, then exhale slowly
• Drink a glass of water quickly
• Swallow a teaspoon of granulated sugar
• Bite on a lemon or taste something sour
• Pull your knees to your chest and lean forward
• Gently massage the back of your neck
• Practice calm, controlled breathing
• Gargle with ice-cold water

Do these remedies work for everyone? The effectiveness of these techniques can vary from person to person. What works for one individual may not work for another. It’s often a matter of trial and error to find the method that works best for you.

When Hiccups Persist: Understanding Chronic Hiccups

While most hiccup episodes are short-lived and harmless, chronic hiccups can be a sign of an underlying medical condition. Persistent hiccups that last for more than 48 hours or recur frequently may be caused by:

• Gastrointestinal disorders (e.g., GERD, ulcers)
• Central nervous system disorders
• Tumors or infections affecting the brain stem
• Certain medications
• Metabolic disorders
• Psychological factors (e.g., stress, anxiety)

Chronic hiccups can significantly impact a person’s quality of life, affecting sleep, eating, and social interactions. If you experience persistent hiccups, it’s crucial to seek medical attention to identify and address any underlying causes.

Diagnostic Approaches for Chronic Hiccups

When evaluating chronic hiccups, healthcare providers may use various diagnostic tools:

• Physical examination
• Blood tests to check for metabolic imbalances
• Imaging studies (e.g., CT scan, MRI) to rule out structural abnormalities
• Endoscopy to examine the upper digestive tract
• Neurological exams to assess nerve function

How long does it typically take to diagnose the cause of chronic hiccups? The diagnostic process can vary depending on the complexity of the case. It may take several appointments and multiple tests to pinpoint the underlying cause.

Medical Interventions: Treating Persistent Hiccups

When home remedies fail and hiccups persist, medical interventions may be necessary. Treatment options for chronic hiccups include:

• Medications: Baclofen, chlorpromazine, or metoclopramide may be prescribed to suppress hiccups
• Nerve blocks: Injecting anesthetic into the phrenic nerve can temporarily stop hiccups
• Surgical interventions: In extreme cases, surgical procedures to disable the phrenic nerve may be considered
• Acupuncture: Some studies suggest acupuncture may be effective in treating persistent hiccups
• Cognitive-behavioral therapy: For hiccups related to psychological factors

Are there any potential side effects of these treatments? As with any medical intervention, these treatments can have side effects. It’s important to discuss the potential risks and benefits with your healthcare provider before starting any treatment.

Hiccups in Special Populations: Children, Pregnant Women, and the Elderly

Hiccups can affect people of all ages, but certain populations may experience them differently or require special considerations:

Hiccups in Children

Hiccups are common in infants and young children, often occurring during feeding. They usually resolve on their own and rarely require intervention. However, if hiccups interfere with feeding or seem to cause distress, consult a pediatrician.

Hiccups During Pregnancy

Pregnant women may experience more frequent hiccups due to changes in the digestive system and the growing uterus putting pressure on the diaphragm. While usually harmless, persistent hiccups during pregnancy should be reported to a healthcare provider.

Hiccups in the Elderly

Older adults may be more susceptible to chronic hiccups due to age-related changes in the body and increased likelihood of underlying medical conditions. Persistent hiccups in the elderly should always be evaluated by a healthcare professional.

Do hiccups pose any risks to these special populations? In most cases, hiccups are harmless. However, persistent hiccups can lead to complications such as dehydration, sleep disturbances, or difficulty eating, which can be particularly problematic for vulnerable populations.

Preventing Hiccups: Lifestyle Changes and Precautions

While it’s not always possible to prevent hiccups, certain lifestyle changes and precautions may help reduce their frequency:

• Eat slowly and chew food thoroughly
• Avoid overeating or eating large meals
• Limit consumption of carbonated beverages
• Manage stress through relaxation techniques
• Avoid sudden temperature changes in food and drink
• Practice good posture, especially while eating
• Quit smoking or avoid other activities that involve inhaling irritants

Can dietary changes help prevent hiccups? For some individuals, identifying and avoiding food triggers can significantly reduce the frequency of hiccup episodes. Keeping a food diary and noting when hiccups occur can help pinpoint potential dietary triggers.

The Role of Hydration in Hiccup Prevention

Proper hydration may play a role in preventing hiccups. Dehydration can lead to electrolyte imbalances, which may increase the likelihood of diaphragm spasms. Aim to drink plenty of water throughout the day, especially before and during meals.

Hiccups and Medical Conditions: When to Be Concerned

While most hiccup episodes are benign, in rare cases, they can be a symptom of a more serious underlying condition. It’s important to be aware of red flags that may indicate a need for medical attention:

• Hiccups lasting more than 48 hours
• Hiccups interfering with eating, sleeping, or breathing
• Hiccups accompanied by severe abdominal pain, fever, or difficulty swallowing
• Hiccups that begin after a medical procedure or starting a new medication
• Hiccups associated with neurological symptoms (e.g., headache, vision changes, weakness)

How quickly should you seek medical attention for concerning hiccups? If you experience any of the above symptoms, it’s advisable to consult a healthcare provider promptly. Early intervention can be crucial in identifying and treating any underlying conditions.

Hiccups as a Symptom of Neurological Disorders

In some cases, persistent hiccups can be a symptom of neurological disorders affecting the brain stem or the nerves controlling the diaphragm. These may include:

• Brain tumors
• Multiple sclerosis
• Stroke
• Encephalitis

While rare, these conditions underscore the importance of seeking medical evaluation for prolonged or recurrent hiccup episodes.

The Psychology of Hiccups: Stress, Anxiety, and Hiccup Episodes

The mind-body connection plays a significant role in many physiological processes, including hiccups. Stress and anxiety can contribute to the onset of hiccup episodes in several ways:

• Altering breathing patterns, potentially leading to diaphragm spasms
• Causing tension in the chest and abdominal muscles
• Increasing the likelihood of swallowing air while eating or drinking
• Exacerbating underlying gastrointestinal issues that may trigger hiccups

Can managing stress help reduce hiccup frequency? For some individuals, stress management techniques such as deep breathing exercises, meditation, or yoga may help reduce the frequency of stress-related hiccup episodes.

The Nocebo Effect and Hiccups

Interestingly, the expectation of experiencing hiccups can sometimes lead to their occurrence – a phenomenon known as the nocebo effect. This underscores the complex interplay between psychological factors and physiological responses in the body.

Hiccups in Popular Culture: Myths and Misconceptions

Hiccups have been the subject of numerous myths, old wives’ tales, and cultural beliefs throughout history. While some of these beliefs may have a grain of truth, others are purely fictional. Let’s examine some common myths about hiccups:

• Myth: Someone is thinking about you when you hiccup
• Fact: Hiccups are caused by diaphragm spasms, not telepathy
• Myth: Holding your breath always cures hiccups
• Fact: While this can work for some, it’s not universally effective
• Myth: Hiccups mean your body is growing
• Fact: There’s no scientific evidence linking hiccups to growth spurts
• Myth: Drinking from the opposite side of a glass cures hiccups
• Fact: This method may work by disrupting breathing patterns, but it’s not a guaranteed cure

Why do these myths persist? Many of these beliefs have been passed down through generations, and the occasional coincidental success of these methods reinforces their perceived effectiveness.

Hiccups in Literature and Media

Hiccups have been featured in various works of literature and media, often as a comedic device or plot point. From children’s books to sitcoms, hiccups have played a role in storytelling across cultures and generations.

Future Directions: Research and Innovations in Hiccup Treatment

As our understanding of the mechanisms behind hiccups grows, researchers continue to explore new treatment options and preventive strategies. Some areas of ongoing research include:

• Targeted medications that specifically address the neural pathways involved in hiccups
• Non-invasive electrical stimulation techniques to regulate diaphragm function
• Advanced imaging studies to better understand the brain’s role in hiccup generation
• Personalized medicine approaches to tailor hiccup treatments to individual patients

What promising treatments are on the horizon for chronic hiccups? While research is ongoing, some emerging therapies show potential, including vagus nerve stimulation and new pharmacological agents targeting specific neurotransmitter systems.

The Role of Artificial Intelligence in Hiccup Research

Artificial intelligence and machine learning are increasingly being applied to medical research, including the study of hiccups. These technologies may help identify patterns and risk factors associated with chronic hiccups, potentially leading to more effective prevention and treatment strategies.

As we continue to unravel the mysteries surrounding hiccups, it’s clear that this common bodily function is far more complex than it might seem at first glance. From its physiological mechanisms to its cultural significance, hiccups remain a fascinating area of study in both medical science and popular culture.

Hiccups – Better Health Channel

Summary

Read the full fact sheet

• Hiccups, or hiccoughs, are involuntary sounds made by spasms of the diaphragm.
• Hiccups are usually harmless and resolve by themselves after a few minutes.
• In some cases, prolonged hiccups that last for days or weeks may be symptomatic of underlying disorders.

Hiccups, or hiccoughs, are involuntary sounds made by spasms of the diaphragm. The diaphragm is a large sheet of muscle slung beneath the lungs that, together with the intercostal muscles, causes us to breathe. The muscular spasm of these muscles sucks air into the lungs, and the quick inhalation makes a structure inside the throat (called the epiglottis) slam shut. (The epiglottis is a flap of tissue that closes over the windpipe during swallowing to prevent the inhalation of food, fluids or saliva.) This sharp closure of the epiglottis causes the characteristic ‘hic’ sound of hiccups.

Generally, hiccups resolve by themselves after a few minutes, but prolonged hiccups that last for days or weeks may be symptomatic of underlying disorders. Certain drugs, including epilepsy medications, can make a person more prone to hiccups.

Symptoms of hiccups

The symptoms of hiccups include:

• A sharp contraction or spasm of the diaphragm that is felt just below the breastbone.
• Air is involuntarily sucked into the throat.
• The closing epiglottis makes a ‘hic’ sound.
• Hiccups usually stop after a few minutes.

Cause of hiccups

The muscular activity of the diaphragm is controlled by nerves. Hiccups occur when particular stimuli trigger the nerves to send the diaphragm into spasms. It is not known why this occurs.

Triggers of hiccups

The cause of hiccups is often unknown and there may be no apparent trigger. Various triggers, particularly those that cause pressure on the diaphragm, are known to prompt an attack of hiccups in some people from time to time. Some of these triggers include:

• Eating food too quickly
• Hot or spicy foods
• Indigestion
• Overconsumption of alcohol
• Fizzy drinks
• Cigarette smoking
• Stress
• Bad odours
• Pregnancy.

Self-help strategies

Hiccups are harmless and usually resolve by themselves in a few minutes. Some hiccup ‘cures’ include:

• Hold your breath
• Take deep breaths
• Breathe into a paper bag
• Eat a bit of fresh ginger
• Suck on a lemon
• Have a hot water and honey drink
• Eat a spoonful of sugar
• Drink a glass of water slowly
• Eat ice
• Gargle
• Sit down and lean forward over your knees
• Ask someone to give you a fright.

Hiccups may be symptomatic of disease

Hiccups that last for days, weeks or even years may be symptomatic of underlying disease. Certain lung or brain disorders can sometimes interfere with the functioning of the diaphragm and make the person prone to hiccups. Hiccups may also be a side effect of surgery or particular medications.

Some of the diseases, conditions and drugs that may prompt frequent or prolonged attacks of hiccups include:

• Oesophagitis (inflammation of the oesophagus)
• An overactive thyroid gland
• Pleurisy (inflammation of the membrane surrounding the lungs)
• Pneumonia (inflammation of the lungs)
• Kidney disease
• Brain damage, such as stroke or tumour, that affects the area of the brain which controls the diaphragm
• Abdominal surgery
• Chest surgery
• Certain epilepsy medications
• Nicotine gum

Medical treatment

Prolonged hiccups should be medically investigated. Treatment options may include:

• Treatment for the underlying disorder
• Changes to current drug dosages
• Switching to another form of nicotine therapy
• Anti-spasmodic drugs to calm the diaphragm
• A tube inserted into the nose (nasogastric intubation)
• A nerve block
• Surgery, to sever some of the nerves servicing the diaphragm.

Where to get help

• Your doctor

Things to remember

• Hiccups, or hiccoughs, are involuntary sounds made by spasms of the diaphragm.
• Hiccups are usually harmless and resolve by themselves after a few minutes.
• In some cases, prolonged hiccups that last for days or weeks may be symptomatic of underlying disorders.

This page has been produced in consultation with and approved
by:

Hiccups – Better Health Channel

Summary

Read the full fact sheet

• Hiccups, or hiccoughs, are involuntary sounds made by spasms of the diaphragm.
• Hiccups are usually harmless and resolve by themselves after a few minutes.
• In some cases, prolonged hiccups that last for days or weeks may be symptomatic of underlying disorders.

Hiccups, or hiccoughs, are involuntary sounds made by spasms of the diaphragm. The diaphragm is a large sheet of muscle slung beneath the lungs that, together with the intercostal muscles, causes us to breathe. The muscular spasm of these muscles sucks air into the lungs, and the quick inhalation makes a structure inside the throat (called the epiglottis) slam shut. (The epiglottis is a flap of tissue that closes over the windpipe during swallowing to prevent the inhalation of food, fluids or saliva.) This sharp closure of the epiglottis causes the characteristic ‘hic’ sound of hiccups.

Generally, hiccups resolve by themselves after a few minutes, but prolonged hiccups that last for days or weeks may be symptomatic of underlying disorders. Certain drugs, including epilepsy medications, can make a person more prone to hiccups.

Symptoms of hiccups

The symptoms of hiccups include:

• A sharp contraction or spasm of the diaphragm that is felt just below the breastbone.
• Air is involuntarily sucked into the throat.
• The closing epiglottis makes a ‘hic’ sound.
• Hiccups usually stop after a few minutes.

Cause of hiccups

The muscular activity of the diaphragm is controlled by nerves. Hiccups occur when particular stimuli trigger the nerves to send the diaphragm into spasms. It is not known why this occurs.

Triggers of hiccups

The cause of hiccups is often unknown and there may be no apparent trigger. Various triggers, particularly those that cause pressure on the diaphragm, are known to prompt an attack of hiccups in some people from time to time. Some of these triggers include:

• Eating food too quickly
• Hot or spicy foods
• Indigestion
• Overconsumption of alcohol
• Fizzy drinks
• Cigarette smoking
• Stress
• Bad odours
• Pregnancy.

Self-help strategies

Hiccups are harmless and usually resolve by themselves in a few minutes. Some hiccup ‘cures’ include:

• Hold your breath
• Take deep breaths
• Breathe into a paper bag
• Eat a bit of fresh ginger
• Suck on a lemon
• Have a hot water and honey drink
• Eat a spoonful of sugar
• Drink a glass of water slowly
• Eat ice
• Gargle
• Sit down and lean forward over your knees
• Ask someone to give you a fright.

Hiccups may be symptomatic of disease

Hiccups that last for days, weeks or even years may be symptomatic of underlying disease. Certain lung or brain disorders can sometimes interfere with the functioning of the diaphragm and make the person prone to hiccups. Hiccups may also be a side effect of surgery or particular medications.

Some of the diseases, conditions and drugs that may prompt frequent or prolonged attacks of hiccups include:

• Oesophagitis (inflammation of the oesophagus)
• An overactive thyroid gland
• Pleurisy (inflammation of the membrane surrounding the lungs)
• Pneumonia (inflammation of the lungs)
• Kidney disease
• Brain damage, such as stroke or tumour, that affects the area of the brain which controls the diaphragm
• Abdominal surgery
• Chest surgery
• Certain epilepsy medications
• Nicotine gum

Medical treatment

Prolonged hiccups should be medically investigated. Treatment options may include:

• Treatment for the underlying disorder
• Changes to current drug dosages
• Switching to another form of nicotine therapy
• Anti-spasmodic drugs to calm the diaphragm
• A tube inserted into the nose (nasogastric intubation)
• A nerve block
• Surgery, to sever some of the nerves servicing the diaphragm.

Where to get help

• Your doctor

Things to remember

• Hiccups, or hiccoughs, are involuntary sounds made by spasms of the diaphragm.
• Hiccups are usually harmless and resolve by themselves after a few minutes.
• In some cases, prolonged hiccups that last for days or weeks may be symptomatic of underlying disorders.

This page has been produced in consultation with and approved
by:

reasons, what to do and how to get rid of at home

Causes of hiccups in newborns

Hiccups in newborns are quite common. To understand why it occurs in a baby and whether it is worth worrying about his health, let’s remember what hiccups are. Between the human chest and the abdominal cavity there is a special respiratory muscle – the diaphragm. When we inhale, it gently rises, when we exhale, it falls.

– Hiccups are sudden contractions of the diaphragmatic muscle when it is irritated, this happens reflexively, – explains Valery Shchelkunova. – At an early age, the diaphragm is very sensitive to various stimuli, since the baby’s nervous system is not yet mature. Therefore, in newborns, hiccups are quite common, this is an absolutely normal process for an infant. Over time, this, of course, passes.

Most often, hiccups in newborns occur after feeding. Directly below the diaphragm is the stomach, and when it is stretched, irritation of the diaphragm can occur. This is mainly due to overeating, or swallowing a large amount of air while sucking on the breast or bottle.

– If we compare breastfeeding and artificial feeding, then in artificially fed children hiccups are observed more often just because of the swallowing of a large amount of air during feeding, – says Valeria Shchelkunova . – The stomach is very distended. But similar problems can occur in breastfeeding babies if the newborn is not properly attached to the breast. Therefore, we ask mothers to pay attention to whether the baby often hiccups after breastfeeding, this may be an indicator of improper attachment.

Also, frequent hiccups, according to the expert, can occur due to bloating, pathology of the gastrointestinal tract or nervous system. In addition, strong emotions, such as fear or joy, as well as a sudden change in temperature, can cause hiccups in a newborn.

What to do with hiccups in newborns

Photo: pixabay.com

First you need to understand the cause of hiccups. If the newborn has swallowed a lot of air, you need to help him burp.

– It is worth taking the child in your arms and holding it in a column for at least 15 minutes, so that the excess air leaves, advises Valeria Shchelkunova . – If the problem is with overeating, you also need to hold the baby after feeding with a column, so the food bolus will move faster. With bloating, which is also a very common problem in newborns and can cause hiccups, since overinflated intestinal loops press on the diaphragm, tummy massage, warmth on the tummy, the use of a gas vent tube, simethicone-based products help first of all. Dill water belongs to the means of non-evidence-based medicine, I do not recommend using them, since their effectiveness is doubtful. The same can be said about the pacifier with syrup. If an objective cause of hiccups cannot be found, the mother should offer the baby a breast or some water if the baby is bottle-fed.

Prevention of hiccups in newborns

Photo: J. Menzel, globallookpress.com

As we have already noted, the main causes of hiccups in newborns after feeding are overeating and swallowing large amounts of air.

“That’s why it’s important not to overeat,” says Valeria Shchelkunova . – If the child is breastfed, then this is feeding on demand, but you need to understand that not every concern of the child is necessarily a desire to eat. If the child is bottle-fed, then you must strictly observe the prescribed norm in food. Make sure the newborn is properly attached to the breast. After feeding, be sure to hold the baby in a column.

To prevent increased gas formation and facilitate gas discharge in a baby, lay him on his tummy more often, do a tummy massage. Try to avoid unnecessary stress and anxiety.

Popular Questions and Answers

Answers Valeriya Shchelkunova — neonatologist, author of the newborn blog .

What not to do with hiccups in newborns

To combat hiccups, people have come up with many ways, ranging from holding their breath, frightening and ending with a headstand. However, their effectiveness is highly questionable. It happens that some parents try to deal with hiccups with similar methods and infants, which is absolutely impossible to do.

– In order for the hiccups to pass, you need to relax the diaphragm. And fear, on the contrary, can become a trigger of tension. So it’s a common misconception that being scared helps with hiccups, our expert explains. – Some people think that holding the breath can also affect the relaxation of the diaphragm. This is also an erroneous opinion. With a lack of air, a reflex contraction of the diaphragm occurs.

When to See a Doctor

As a rule, hiccups in newborns are not dangerous, and there is nothing for parents to worry about.

— But if it occurs systematically, just after feeding, and the mother is very worried, it is worth contacting a doctor for advice, advises Valeria Shchelkunova . – It is possible that the baby is not properly attached to the breast, for this reason, feeding may not be effective, which may lead to poor growth performance.

Also, the reason for going to the doctor may be too long bouts of hiccups, which are accompanied by pain in the baby’s tummy (he can twist his legs during hiccups, cry a lot).

How to provide first aid for hiccups

No special actions and manipulations are required in case of hiccups in a newborn. As we have already noted, after feeding, with hiccups that have begun, you need to vilify the child for some time with a column. If you supplement your child with water, then during an attack of hiccups, you can give him a drink. Pay attention to the conditions in which the baby is located: it is cold or hot in the room, perhaps the newborn is cold. Try to distract the baby: play with him, talk, do a light massage.

Involvement of the area postrema as a cause of uncontrollable hiccups, nausea and vomiting in diseases of the myelitis optic spectrum (observation from practice)

Hiccups, nausea and vomiting are among the most common symptoms in general clinical practice. They can be the result of a large number of organic and functional diseases of the gastrointestinal tract, manifestations of infectious pathology and acute poisoning, symptoms of diseases of the cardiovascular system, kidneys, side effects of many drugs [1]. Diagnosis of the corresponding diseases, especially with the isolated appearance of these symptoms, often causes difficulties.

When the nervous system is damaged, nausea and vomiting (emetic syndrome) most often occur as cerebral symptoms as part of hypertension or meningeal syndrome, as well as with a gross structural lesion of the posterior cranial fossa, combined with other signs of brain damage. Extremely rarely, nausea, vomiting and hiccups occur in isolation due to damage to the trigger center of the gag reflex in the area of ​​the bottom of the IV ventricle and area postrema .

Here is a clinical observation of a patient in whom nausea, vomiting and hiccups were the first clinical manifestations of a disease from the optomyelitis spectrum.

Patient K. , aged 29, was first consulted at the Neurology Research Center in December 2015.

From the anamnesis it is known that for a long time the patient had an increase in ESR up to 55 mm/h, dry mouth. In 2013, she was examined by a rheumatologist. Laboratory examination revealed an increase in rheumatoid factors up to 457 mU/ml (the norm is less than 30 mU/ml), ultrasound revealed a diffusely heterogeneous structure of the salivary glands. Consulted by a dentist: cervical caries, hardening of the salivary glands, sialometry 2.0 ml. No further examination was carried out.

In September 2015, a month after the birth, hiccups appeared, which after a few days became indomitable. A week later, a constant feeling of nausea joined, there was repeated vomiting of gastric contents, which did not bring relief and was not associated with food intake. She was hospitalized in a gastroenterological hospital with a diagnosis of acute pancreatitis. An additional examination revealed an increase in urine amylase activity up to 2285 U/l (norm – up to 447 U/l), blood amylase up to 150 U/l (normal – 28-100 U/l), however, during ultrasound and MSCT of the abdominal organs no diagnostically significant changes were observed in the cavity. During gastroscopy, signs of non-erosive esophagitis, gastroesophageal reflux were revealed. It is suggested that there is a neuroendocrine tumor of the pancreas. According to the laboratory examination, the concentration of insulin, gastrin, somatotropic hormone in the blood serum is within the normal range. Given the lack of data on damage to the gastrointestinal tract (GIT) and the association of nausea and vomiting with food intake, it was suggested that the symptoms had a central genesis, in connection with which an MRI of the brain was performed, according to the results of which, according to the conclusion, no diagnostically significant changes were detected. was. Discharged with a diagnosis of gastroesophageal reflux disease, non-erosive reflux esophagitis. 2 weeks after discharge, hiccups, nausea and vomiting completely regressed.

In November 2015, numbness of the right leg occurred, spreading to the right half of the abdomen, weakness in the right arm and leg, hiccups reappeared. Hospitalized in the Scientific Center of Neurology.

In the neurological status, right-sided moderate spastic hemiparesis, a gross violation of the articular-muscular sensation in the right hand (up to the level of the elbow joints), a moderate decrease in surface sensitivity according to the conduction type to the C2 level on the left were determined. MRI of the cervicothoracic spine revealed a hyperintense lesion in T2 mode at the level of C2—Th2 with active uneven accumulation of contrast agent and a hyperintense lesion in T2 and FLAIR modes in the area of ​​the bottom of the IV ventricle and area postrema , which also accumulates a contrast agent. In addition, when reviewing the MRI results from October 2015, an area of ​​hyperintense MR signal in T2 and FLAIR modes was found in the area of ​​the IV ventricle fundus.

Laboratory examination revealed: mild hypochromic anemia (hemoglobin 117 g/l), lymphocytic pleocytosis in cerebrospinal fluid (38/3), positive antinuclear factor, SS-A antibodies (RO) in titer 1:640 (norm – less than 1 :320), antibodies to aquaporin-4 — 26 U/ml (normal — less than 3 U/ml).

Given the presence of longitudinal myelitis, lesion area postrema and antibodies to aquaporin-4, the diagnosis was made: opticomyelitis-associated disorder. Conducted pulse therapy with methylprednisolone (total 7000 mg), high-volume plasmapheresis (71 ml/kg) with a positive effect in the form of regression of hemiparesis, sensory disorders, hiccups. She was later examined by a rheumatologist and diagnosed with Sjögren’s syndrome.

Optocomyelitis (opticoneuromyelitis, Devic’s disease) is an autoimmune disease of the nervous system, characterized by a combination of optic neuritis and transverse myelitis [2]. For a long time, this disease was regarded as a special opticospinal variant of multiple sclerosis. The situation changed dramatically in 2004, when specific antibodies called NMO-IgG 9 were detected in the blood of patients.0073 ( neuromyelitis optica ), and a year later, the antigen that is the target for these antibodies, the aquaporin-4 water channel, was identified [3–5].

The discovery of a specific molecular biomarker made it possible to significantly expand the clinical spectrum of aquaporin-associated symptoms and conditions, for the description of which it is proposed to use the term “spectrum of myelitis optic disorders” [6–7]. Clinical manifestations in patients with antibodies to aquaporin-4 can be represented not only by signs of damage to the spinal cord (longitudinally advanced myelitis) and optic nerves (optic neuritis), but also signs of damage to the fundus of the IV ventricle and area postrema (uncontrollable hiccups, nausea, vomiting), brain stem (oculomotor disorders, hearing loss and dizziness), diencephalic region (narcolepsy, hypersomnia, hypothermia, weight loss and other endocrine disorders). All these syndromes are characterized by high expression of aquaporin-4 [8].

Syndrome of lesion area postrema and the bottom of the IV ventricle in the form of indomitable hiccups, nausea and vomiting is the third most common clinical manifestation of the spectrum of optomyelitis-associated disorders after myelitis and optic neuritis [9]. In 2015, diagnostic criteria for diseases of the myelitis optic spectrum were published, according to which the lesion of area area postrema is the main clinical manifestation. If antibodies to aquaporin-4 are detected in the blood serum of a patient with this syndrome, the diagnosis of myelitis optica spectrum disease is established immediately; area postrema with corresponding changes on MRI [10].

Lesion area postrema is detected in 16—43% of patients, and in 12% of cases it is the first clinical manifestation of the disease [10—15], which corresponds to the data of the presented observation. Proper diagnosis in this situation is extremely difficult. In the vast majority of cases, patients are seen by gastroenterologists, internists or general practitioners and they undergo an extended examination of the gastrointestinal tract, which, however, does not reveal diagnostically significant changes [14–18].

In the case presented, hiccups, nausea, and vomiting in a young patient occurred in the postpartum period, which is a risk factor for the onset of opticomyelitis spectrum diseases [19]. Despite an increase in amylase activity in urine and blood serum, during ultrasound and MSCT of the abdominal organs, gastroscopy revealed no changes that could explain the existing symptoms. Attention was also drawn to the persistent persistent nature of the symptoms for several weeks, the absence of a connection between nausea and vomiting and food intake, as well as other signs of gastrointestinal damage. The final confirmation of the central genesis of hiccups, nausea and vomiting are the results of neuroimaging, which revealed a pathological focus in area postrema with accumulation of a contrast agent, which indicates the activity of the process.

To date, the relationship between the defeat of area postrema and the development of hiccups, nausea and vomiting has been convincingly proven. Thus, ablation of this area effectively stops vomiting after surgical interventions [20], and experimental studies have revealed an increase in the frequency of discharges of neurons area postrema during vomiting of protective origin [21]. It is assumed that the frequent defeat of area postrema and the bottom of the IV ventricle in myelitis optic-associated disorders can be associated both with the high expression of aquaporin-4 by astrocytes in these areas, and the presence of fenestrated capillaries in the blood-brain barrier and abundant vascularization of this area, which facilitates the penetration of serum antibodies and their binding with antigen [13].

In the present observation, the symptoms of the area postrema lesion regressed on their own within several weeks in the absence of specific treatment, which is consistent with the data of other authors [12, 14] on the reversibility of clinical and neuroimaging signs of damage to this area (in contrast to lesions of the spinal cord and visual nerves). It is assumed that this may be due to the peculiarities of the functioning of astrocytes in this localization, in particular, the low expression of the excitatory amino acid transporter EAAT 2 (Excitatory Amino Acid Transporter 2) and the use of mechanisms independent of it for regulating the content of glutamate in the synaptic cleft. In spinal cord astrocytes, EAAT 2 is non-covalently bound to aquaporin-4 and internalized together with it under the action of specific antibodies. This leads to impaired glutamate reuptake, an increase in the entry of calcium ions into the cell, and calcium-dependent neuron death [14, 22].

Diagnostic difficulties in the presented observation are also associated with the presence of clinical and immunological signs of Sjögren’s syndrome in the patient. At present, the relationship between opto-myelitis-associated disorders and systemic diseases of the connective tissue has been proven. Patients with opticomyelitis often have a variety of antibodies even in the absence of clinical manifestations of other autoimmune diseases [23]. Approximately 1/3 of patients with Sjögren’s syndrome and lesions of the nervous system have antibodies to aquaporin-4, and the clinical picture corresponds to a lesion from the opticomyelitis spectrum [24]. It is believed that such cases should be regarded not as neurological complications of a systemic disease, but as its combination with a myelitis optic-associated disorder [23].