What Are Hiccups? What Causes Hiccups?

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Main Category: Respiratory / Asthma
Article Date: 08 Mar 2010 - 0:00 PDT

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A hiccup, also known as hiccough, synchronous diaphragmatic flutter (SDF), or singultus is a common condition that probably affects every human, in which there is an involuntary esophageal contraction of the diaphragm that recurs several times per minute. The diaphragm is the muscle that separates the chest from the abdomen - it is underneath the ribcage - and has a key function in breathing.

The sudden rush of air into the lungs causes the epiglottis to close, creating that hic sound. The epiglottis is an elastic cartilage flap, covered with a mucus membrane and is attached to the root of the tongue.

A hiccup is an involuntary action involving a reflex arc (the neural pathway that mediates a reflex action) - we have no control over it. Most experts agree that they do not appear to have any useful purpose.

In most cases a bout of hiccups eventually goes away on its own without medical intervention. In chronic cases medical treatment may be necessary. According to The Mayo Clinic, USA, about 1 in every 100,000 bouts of hiccups may persist for months. Hiccups that last for long periods are categorized into two types:

• Persistent (protracted) hiccups - they last over 48 hours, but no more than one month.
• Intractable hiccups - they persist for longer than one month.

Home remedies for curing hiccups form part of the folklore of most societies around the world. Examples include drinking a specific amount of water rapidly, giving the sufferer a sudden scare (fright), breathing into a paper bag, to swallowing some substance that usually comes from the kitchen.

Hiccups may occur after eating a lot, consuming alcohol, malnutrition, exhaustion, or experiencing sudden excitement. Hiccups are very rarely seen as a sign or symptom of some underlying medical condition.

In many Western societies people apologize with an "excuse me" after they hiccup. However, it is seen with amusement rather than scorn. Hiccups are much more socially acceptable than burps or breaking wind (farting).

Short-term hiccups affect both males and females equally, although persistent and intractable hiccups tend to affect males more.

According to Medilexicon's medical dictionary a hiccup is "A diaphragmatic spasm causing a sudden inhalation that is interrupted by a spasmodic closure of the glottis, producing a noise."

What are the signs and symptoms of hiccups?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.

The only sign of a hiccup is its characteristic sound.

The individual with hiccups may experience slight tightening in the chest, abdomen or throat just before hiccupping.

Between 5 and 60 hiccups may be emitted in one minute.

In most cases, there is no need to see a doctor unless the hiccups persist for more than 48 hours.

What are the risk factors for hiccups?

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.

Gender - males are more likely to develop hiccups that last for more than 48 hours than women.

Surgical procedures - some factors involved in surgical procedures seem to raise the risk of developing hiccups that last for more than 48 hours. Examples include:

• A general anesthetic
• Abdominal distension (distended abdomen) - swelling of the abdomen, which can occur after an endoscopy is performed through small incisions.
• Intubation - when a tube is placed into a hollow organ or passageway. In this case, down the throat into the airway to help the patient breathe.
• Neck extension - these are used during intubation.
• Organ manipulation

The patient's mental and/or emotional state - experts say there may be a link between stress, anxiety, grief, and over-excitement and bouts of hiccups.

What are the causes of hiccups?

A hiccup takes place when the diaphragm involuntary and suddenly squeezes (contracts), causing the individual to inhale rapidly. The glottis responds to this sudden rushing in of air by closing, producing the distinctive hiccup sound.

Short-term hiccups - nobody really knows why hiccups occur. We all get them occasionally. They are normal and nothing to worry about. They tend to occur more frequently:

• After consuming alcohol
• After drinking quickly (linked to stomach being bloated)
• After eating quickly (linked to stomach being bloated)
• When exposed to abrupt temperature changes
• When the stomach is bloated

Short-term hiccups nearly always go away on their own and require no specific treatment.

Persistent and intractable hiccups - if a bout of hiccups persists for over 48 hours, there is a good chance it has some underlying cause. Examples include:

• GERD (Gastroesophageal reflux disease) - occurs when gastric acid from the stomach goes up into the esophagus, often causing inflammation of the esophagus - esophagitis. Reflux refers to the upward or reverse movement from the stomach upwards to the esophagus. Often called acid reflux.
  
  
• Gastritis - stomach inflammation.
  
  
• A small bowel obstruction
  
  
• A tumor
  
  
• Pneumonia - an infection of the lungs that is caused by bacteria, viruses, fungi, or parasites. It is characterized primarily by inflammation of the alveoli in the lungs or by alveoli that are filled with fluid (alveoli are microscopic sacs in the lungs that absorb oxygen). At times a very serious condition, pneumonia can make a person very sick or even cause death.
  
  
• Eardrum - something may be touching the eardrum, such as a hair.
  
  
• Pericarditis - inflammation of the pericardium (the lining around the heart).
  
  
• Heart attack (myocardial infarction) - if the heart muscle does not have enough blood (and consequently oxygen) it dies and a heart attack occurs.
  
  
• Stroke - a blood clot or ruptured artery or blood vessel interrupts blood flow to an area of the brain. A lack of oxygen and glucose (sugar) flowing to the brain leads to the death of brain cells and brain damage.
  
  
• Multiple sclerosis (MS) - the central nervous system (CNS) is attacked by the person's own immune system. That is why MS is known as an auto-immune disease. The CNS includes the brain, spinal cord and optic nerves.
  
  
• Addison's disease - chronic (long-term) insufficiency of the adrenal cortex; the outer-portion of the adrenal gland underfunctions. U.S. President J.F. Kennedy is said to have had Addison's disease. Symptoms include tiredness, dizziness, muscle weakness, weight loss, problems standing up (blood pressure drops), diarrhea, headache, anxiety and changes in personality and mood.
  
  
• Goitre - enlargement of the thyroid gland (not cancerous). Usually painless, however, if the gland gets very large the patient may have problems swallowing properly, and may also develop a cough.
  
  
• Hyperglycemia - when blood glucose is too high; it is the opposite of hypoglycemia. Hyperglycemia needs to be treated immediately as it is a major cause of complications among people with diabetes.
  
  
• Anorexia nervosa - a psychological disorder. The patient has a distorted body image and an irrational fear of becoming overweight - so he/she deliberately attempts to lose weight. Even though the majority of patients are female, men can also suffer from Anorexia Nervosa.
  
  
• Meningitis - inflammation of the membranes of the brain or spinal cord.
  
  
• Encephalitis - inflammation of the brain resulting from a viral infection.
  
  
• Traumatic brain injury - the result of a sudden, violent blow or jolt to the head. The brain is launched into a collision course with the inside of the skull, resulting in possible bruising of the brain, tearing of nerve fibers and bleeding.
  
  
• Electrolyte imbalance - an electrolyte is any substance that contains free ions that behaves as an electrically conductive medium (conducts electricity). All higher forms of life cannot exist without electrolytes, and that includes humans. In our bodies, electrolytes include sodium (Na⁺), potassium (K⁺), calcium (Ca²⁺), bicarbonate (HCO₃^-, magnesium (Mg²⁺), chloride (C1^-), hydrogen phosphate (HPO₄^2-), and hydrogen carbonate (HCO₃^-). Electrolytes regulate our nerve and muscle function, our body's hydration, blood pH, blood pressure, the rebuilding of damaged tissue. Various mechanisms exist in our bodies that keep the concentrations of different electrolytes under strict control.
  
  
• Kidney failure - the kidneys stop working and cannot remove waste and excess water from blood, or keep body chemicals in balance.
  
  
• Some infections - especially those that cause a sore throat or laryngitis.
  
  
• Some medications - such as benzodiazepines or corticosteroids.

Long-term hiccups may sometimes persist with no underlying cause ever being found.

Diagnosing hiccups

For the first 48 eight hours it is not generally necessary to see a doctor, as in most cases symptoms will go away on their own. Patients whose symptoms persist for over 48 hours should see their GP (general practitioner, primary care physician). The doctor will carefully examine the patient's medical history, ask some questions about recent activities, and carry out a physical examination. The doctor's aim is to rule out any possible illnesses or conditions that may be the cause of the hiccups. If the GP suspects or diagnoses an underlying disease/condition, the patient may be referred to a specialist.

If an underlying condition is suspected the doctor may order some diagnostic tests, these may include:

A blood test - to check for infections, kidney disease or diabetes.

Imaging tests - these tests will determine whether there are any anatomical abnormalities that may be affecting the vagus or phrenic nerves, or the diaphragm. Examples of tests include:

• A chest X-ray
• A CT (computerized tomography) scan
• An MRI (magnetic resonance imaging) scan

The doctor may also order an ECG (electrocardiogram), which measures the electrical activity of the heart to rule out any heart conditions.

Endoscopic test - this is used to check the windpipe (esophagus). A thin, flexible tube (endoscope) with a tiny camera at the end is passed down the patient's throat.

What are the treatment options for hiccups?

In the majority of cases hiccups will go away without any need for medical intervention.

According to the National Health Service (NHS), UK, some patients have found the following may help stop the hiccups:

• Bite on a lemon
• Breathe into a paper bag (this should never be placed over the person's head)
• Hold your breath for short periods
• Lean forward so that the chest is compressed
• Sip ice-cold water
• Sit with the knees pulled up to the chest
• Swallow granulated sugar
• Taste a bit of vinegar

If it is found that the hiccups are being caused by an underlying condition, that cause needs to be treated (and the hiccups may go away). Hiccups that have persisted for over 48 hours may receive the following treatments:

Medication may be used if other treatments have not worked, or if no underlying cause is found. According to the National Health Service (NHS), UK, there is not enough research around to know how effective medications are for hiccups. The following medications may be prescribed:

• Baclofen
• Chlorpromazine
• Gabapentin
• Haloperidol
• Metoclopramide

An initial course of treatment will be about two weeks long. The doctor may then increase the dosage until symptoms are controlled. Some patients may respond well within a week, while for others it can sometimes take a few months. Doctors say that the majority of patients whose symptoms cleared up while taking their medication do not usually have a recurrence when they stop (taking the medication). Rarely, symptoms return when medication is stopped. In such cases patients may have to take the drug for longer.

Surgical procedures:

• Nasogastric tube - if the patient's stomach has swollen (is distended), a long, thin, flexible tube (nasogastric tube) is inserted through the nose and into the stomach. Sometimes this procedure stops the hiccups.
  
  
• Nerve block - an anesthetic is injected that blocks the phrenic nerve, stopping the hiccups.
  
  
• Vagus nerve stimulation - a device is surgically implanted into the patient's chest. It delivers mild electrical stimulation to the vagus nerve.

What are the possible complications of hiccups?

A person with long term hiccups may have problems sleeping, eating, and even talking properly. There may also be problems with healing after surgery.

Preventing hiccups

Some of the causes of hiccups are preventable.

• Avoid abrupt changes in temperature
• Avoid drinking alcohol
• Avoid fizzy drinks
• Avoid having large meals
• Do not eat too rapidly

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today