SYMPTOMS

What is hiccup?

Medically, hiccup refers to what is commonly known as "hiccups." It occurs when certain stimuli cause excessive excitation of the phrenic nerve and/or vagus nerve, leading to a sudden rush of air from the stomach to the throat, producing a short, sharp sound. This is a common clinical manifestation caused by diaphragmatic spasms^[1]. If hiccups cannot be self-controlled—meaning they occur but do not resolve on their own—other interventions may be necessary to stop them promptly.

What are the classifications of hiccups? What are the specific manifestations?

There are two classification methods^[1].

Based on frequency, hiccups can be divided into:

• Acute hiccups: A single episode lasts for a relatively long time, up to 48 hours at most, with fewer occurrences. After stopping, they usually do not recur.
• Chronic hiccups: Persistent or recurrent, often pathological. Episodes can last for days or even weeks.

Based on duration, hiccups can be divided into:

• Occasional hiccups: Transient hiccups that resolve quickly on their own. The duration is short, lasting minutes or hours.
• Intractable hiccups: Lasting longer than 48 hours. Severe intractable hiccups can interfere with normal eating and breathing, even leading to systemic exhaustion, causing significant distress to the patient.

TREATMENT

How to Relieve Hiccups?

1. General Relief Methods: Certain physical actions or maneuvers may stop hiccups. These methods are relatively simple and safe, aiming to disrupt normal breathing, stimulate the nasopharynx or vagus nerve, or ease diaphragm irritation. However, their effectiveness is not entirely certain^[2]. The following methods can be tried during hiccups:

   • Hold your breath for 5–10 seconds.
   • Take a deep breath, hold it, tighten your abdominal and chest muscles, maintain for 5 seconds, then exhale quickly (similar to holding your breath and then coughing).
   • Gargle with ice water.
   • Bite a lemon or eat a small spoonful of sugar, which may stimulate the back of the throat to relieve hiccups.
   • Wash your hands or use a clean gauze to cover your tongue, then gently pull your tongue outward.
   • While sitting, lean forward to bring your knees to your chest and hold for 30 seconds to 1 minute.
   • Drink water quickly through a small straw, which may stimulate the phrenic or vagus nerve to relieve hiccups.

2. Medication and Surgical Treatment: If hiccups persist for more than 2 days despite the above methods, it is recommended to visit a gastroenterologist for evaluation, diagnosis, and appropriate treatment. Possible treatments include:

   • Medication: The principle of drug therapy is to block nerve transmission. Commonly used medications include dopamine receptor antagonists (e.g., domperidone, metoclopramide) and GABA-B receptor agonists (e.g., baclofen)^[1,3].
   • Surgical Treatment: Since hiccups involve the phrenic nerve, surgical methods aim to block its transmission, such as radiofrequency ablation or anesthetic nerve blocks. However, surgery carries significant risks and is only considered when medications fail. This approach should be used with extreme caution^[1,3].

DIAGNOSIS

When should you seek medical attention for hiccups?

Simple, transient hiccups do not require a hospital visit, as they usually resolve on their own or can be stopped with general relief methods, posing no serious harm.

If hiccups persist and cannot be relieved, affecting work or rest, or if the patient has a history of cranial, mediastinal, or digestive system diseases, they should promptly go to the hospital to identify the cause to avoid delaying diagnosis and treatment.

Which department should you visit for hiccups?

Gastroenterology.

POTENTIAL DISEASES

What are the possible causes of hiccups?

1. Central hiccups: Central hiccups result from the loss of inhibitory function in the hiccup reflex arc and organic lesions. Organic lesions include medulla oblongata disorders, brain tumors, cerebral thrombosis, cerebral embolism, cerebrovascular accidents, encephalitis, and meningitis. Metabolic disorders include uremia, alcohol intoxication, and multiple sclerosis^[1,4].

2. Peripheral hiccups: Phrenic nerve irritation includes mediastinal tumors, esophagitis, esophageal cancer, and thoracic aortic aneurysms. Lesions around the diaphragm include pneumonia, pleurisy, pericarditis, myocardial infarction, subphrenic abscess, hiatal hernia, and gallbladder diseases. Vagus nerve irritation includes gastric distension, gastritis, gastric cancer, pancreatitis, and electrolyte imbalances^[1,2].

3. Others:

   • Iatrogenic hiccups: Caused by chemotherapy/radiotherapy, post-abdominal or mediastinal surgery, laparoscopy or postoperative effects, and certain medications^[1,2].
   • Psychological causes: Hysterical hiccups, nervousness, etc.^[1,2].
   • Physiological hiccups: Temporary diaphragm dysfunction due to cold exposure or improper diet irritating the phrenic nerve^[1,2].

How to prevent hiccups?

Actively treat underlying conditions such as brain disorders or uremia^[2].

Avoid overeating, excessive alcohol consumption, and irritating foods.