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PubMed1998

Intractable hiccups during stroke rehabilitation.

OBJECTIVE: To study the frequency of intractable hiccups during stroke rehabilitation and the impact on rehabilitation management. DESIGN: Case series, retrospective chart review. SETTING: Inpatient stroke rehabilitation floor within a tertiary care teaching hospital. PATIENTS: Three patients admitted for stroke rehabilitation with hiccups of at least 48 hours out of 270 consecutive cases. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Response to pharmacologic treatment. RESULTS: All three subjects had pontine infarcts and required gastrostomy tube feedings and lengthy rehabilitation stays. Subjects suffered from significant complications including aspiration pneumonia, respiratory arrest, and nutritional depletion. Chlorpromazine treatment was terminated in all three subjects because of sedation that interfered with therapies. Treatment with carbamazepine was successful in only one patient; in the other two subjects, their hiccups were controlled with haloperidol or baclofen. All subjects were ultimately managed with a single agent. CONCLUSIONS: Pharmacologic interventions for intractable hiccups must be tailored to the unique circumstances of the stroke rehabilitation patient. Intractable hiccups can be associated with potentially fatal consequences, and safe management may require an inpatient rehabilitation setting and multidisciplinary team approach to optimize the feeding management of this challenging population.

Aged↗
PubMed2006

Protracted hiccups due to severe erosive esophagitis: a case series.

BACKGROUND: Hiccups although a common annoyance of life, have been linked with significant morbidity and even death. There are numerous causes of prolonged hiccups, including diseases of the gastrointestinal tract. Hiccups are reported to represent an atypical manifestation of gastroesophageal reflux disease. CASES: We report 4 cases of prolonged hiccups in patients who failed to respond to initial treatment with abortive neurologic medications and who subsequently improved on proton-pump inhibitors. Endoscopic examination revealed severe reflux esophagitis. CONCLUSION: Hiccups are an atypical manifestation and may represent a more severe course of gastroesophageal reflux disease.

Adult↗
PubMed2002

Retrospective analysis of hiccups in patients at a community hospital from 1995-2000.

Hiccups are a physiologic phenomenon noted in animals and humans. There is little understanding of what makes hiccups occur and whether or not they have any productive purpose. A retrospective analysis of all patients seen in a community hospital over a 5 year period was conducted to see who is affected by hiccups, evaluate laboratory findings in people with hiccups, and to see what the currently accepted treatment is for hiccups. The vast majority of patients were male, older than 50 years of age, and with co-morbid conditions. Laboratory values appeared to be of little value in determining whether treatment interventions would be effective. Gastroenterology was the service most consulted and EGD the most common procedural intervention conducted, but with little success. No treatments showed a statistically significant effect.

Adolescent↗
PubMedDate not supplied

The effect of ketamine in patients with refractory hiccup in the postoperative period. Preliminary report.

In 5 cases of refractory postoperative hiccup the authors observed a favourable effect of a single dose of ketamine administered intravenously. Earlier applied procedures and drugs failed to control hiccup or alleviated it for only a short time. In all cases the overfilling of the stomach was ruled out as a cause of hiccup by routine preliminary examination. The doses of ketamine used (0.5 mg/kg of body weight) caused no central nervous system disturbances in postoperative patients. In view of the small number of observed cases the authors regard this report as a preliminary communication and as an encouragement for further investigations on the usefulness of ketamine in the treatment of postoperative hiccup and also in treatment of hiccup in patients in other medical specialities.

Drug Evaluation↗
PubMed1992

[A case of multiple sclerosis with intractable hiccups and sleep apnea syndrome].

A 48-year-old female with multiple sclerosis (MS) accompanied by intractable hiccups of over one month' duration and the sleep apnea syndrome was reported. This MS patient had been well controlled until September 16, 1991 when she experienced nausea, vomiting and hiccups. The patient was admitted to Kawasaki Medical School Hospital on October 9, 1991. A physical examination revealed intractable hiccups. T1-weighted MRI showed a low and T2-weighted image disclosed a high signal intensity area in the tegmentum of the medulla oblongata. The intractable hiccups and vomiting improved with intravenous high dose methylprednisolone injection therapy. The following day, she complained of insomnia and her family observed severe snoring and apnea during the night. These symptoms and the results of a breathing monitor were compatible with the sleep apnea syndrome. These symptoms disappeared following the administration of amitriptyline. There have been few reports of the combination of intractable hiccups and the sleep apnea syndrome in MS. The MRI findings suggest that the causative lesion of these symptoms is in the tegmentum of the medulla oblongata.

Amitriptyline↗
PubMed2005

[Hiccups].

Hiccups are a common phenomenon but little is known about their pathophysiological mechanism or function. The concept of a hiccup reflex lacks a scientific basis. Closure of the glottis may be caused by an active contraction or by a passive, sudden myoclonic contraction of the inspiratory musculature, leading to a rapid reduction in intrathoracic pressure. Hiccups are often benign and of short duration but they can sometimes be a serious medical problem due to their chronicity and underlying causes. Many remedies for hiccups have been reported, such as manoeuvres, medical treatment and invasive procedures. Chlorpromazine is the only drug that is registered for the treatment of persistent hiccups but it has many side effects. Baclofen is often used in practice, and favourable experiences with piracetam are known.

Baclofen↗
PubMedDate not supplied

[Persistent hiccup: causes, diagnosis and treatment].

Hiccup is a common phenomenon produced by the activation of a primitive reflex, which has its own center in the central nervous system. Most episodes last only a few minutes and are self-limited, but hiccup can get persistent and become a real problem for physician and patient alike. The center of hiccup may be activated by a great variety of stimuli travelling along different nerve path ways and bring different effector responses. Causes of hiccup are various and merit a systematic study of any patient with persistent hiccup.

Hiccup↗
PubMedDate not supplied

Intractable hiccups: the role of cerebral MR in cases without systemic cause.

PURPOSE: To look for central nervous system abnormalities as possible causes of intractable hiccups. METHODS: Of a series of 50 patients with chronic (ie, lasting more than 48 hours) hiccups, a prospective study identified a subgroup of 9 patients with no clinical or gastroesophageal abnormalities (according to endoscopy, pH monitoring and manometry). We performed in all 9 patients brain and upper cervical cord MR examination with precontrast and postcontrast T1- and T2-weighted sequences. A study of the last cranial nerves was done with thin T2-weighted imaging (constructive interference in a steady state sequence). The cervical cord and parapharyngeal space were systematically explored using coronal T2- and sagittal T1-weighted imaging. RESULTS: Five of these 9 patients had definite MR abnormalities located in the temporal lobe (3 cases), cerebellopontine angle (1 case), or areas of high signal intensity compatible with demyelination (1 case). The relationship between hiccups and infratentorial abnormalities in 2 cases was doubtful (vascular loop and prominent posterior condylar canal). MR findings in 2 cases were considered normal. CONCLUSIONS: Brain MR is a useful investigation in patients with chronic hiccups when gastroesophageal lesions are either excluded or too mild to account for an intractable hiccup.

Adult↗
PubMed1992

Premedication with metoclopramide decreases the frequency of methohexital induced hiccup.

Metoclopramide is one of many drugs that have been recommended for the treatment of intractable hiccup. Methohexital may produce hiccup during induction of general anesthesia. 211 women received methohexital for induction and maintenance of general anesthesia for short gynaecological procedures. All the patients were premedicated with fentanyl, diazepam and atropine. 109 patients were randomly selected to receive metoclopramide before induction of anesthesia; the remaining 102 patients served as a control group, and were anesthetized without metoclopramide premedication. The frequency of hiccup was compared between the two groups. 7 patients had hiccup in the metoclopramide premedicated group, as compared to 17 patients in the control group. This difference was statistically significant. We conclude that metoclopramide reduces the frequency of methohexital induced hiccup, and recommend that metoclopramide be routinely used for the premedication of methohexital injection.

Clinical Trial↗
PubMed2003

Persistent hiccups associated with intravenous corticosteroid therapy.

Singulata, commonly known as hiccups, have many causes and are most often idiopathic and short-lived. Occasionally, hiccups can be persistent and becoming quite bothersome, distracting, and even disabling. Many medications have been implicated as a cause of hiccups. Although uncommon, corticosteroids and benzodiazepines are 2 classes of drugs most frequently associated with the development of hiccups. The following case series describes 5 patients with intravenous corticosteroid-associated hiccups reported to our adverse drug reaction reporting system between January 1998 and December 2000. Physicians using intravenous corticosteroids should be aware of this potential complication.

Journal Article↗
PubMed1992

Hiccups. A case presentation and etiologic review.

Hiccups (singultus) usually present as a common annoyance lasting for short periods. Rarely, they may be the harbinger of a serious disease. We present the case of a 19-year-old man in which intractable hiccups was the first and most prominent symptom of a serious underlying neurologic disorder. The patient had been examined by his pediatrician, and despite multiple medical regiments and physical maneuvers, his symptoms persisted. A thorough head and neck examination revealed a right-sided vocal cord paralysis. This finding prompted obtaining a magnetic resonance imaging scan, which demonstrated a type I Arnold-Chiari malformation associated with a large cervicothoracic syringomyelia. The patient was referred to the neurosurgical service and subsequently underwent a ventriculoperitoneal shunt placement. There was considerable initial improvement in his neurologic status and cessation of the hiccups. However, the symptoms recurred within 1 month. The case report as well as a brief review of the relevant pathophysiologic and etiologic considerations and several treatment modalities for hiccups is presented.

Adult↗
PubMed2002

Intractable hiccup: an odd complication after laparoscopic fundoplication for gastroesophageal reflux disease.

Intractable hiccup can be an unbearable circumstance and its treatment is often frustrating. More than 100 causes for hiccup have been described in the literature; the most common cause is gastroesophageal reflux disease (GERD). We report a case of a 31-year-old patient who suffered from intractable hiccup starting 3 weeks after laparoscopic Nissen fundoplication for GERD, a potential surgical complication that has not been described. After frustrating medical treatment, the patient underwent computed tomography and nerve stimulator-guided blockade of vagal and phrenic nerves on each side separately. Hiccup ceased only after blockade of the right phrenic nerve with 4 ml/h l% ropivacaine and relapsed soon after discontinuation. He underwent thoracoscopic right phrenicectomy, which rendered him symptom free for well over 2 months, at the time of this writing.

Adult↗
PubMed1989

Fetal hiccups; characteristics and relation to fetal heart rate.

In 35 two-hour recordings of fetal heart rate and fetal movements, 14 periods of fetal hiccups were present (1.2% of the recording time) with a median duration of 3.5 min (range 1 to 8 min). No specific relation to behavioural states or movement patterns could be identified. The hiccupping frequency varied from 10 to 21 per min. Within a hiccupping spell, the mean frequency decreased from 20 +/- 11 to 12 +/- 6.2 per min. A small but evident increase in baseline frequency was present during the hiccupping spells, independent from other movements performed by the fetus.

Electrocardiography↗
PubMed1996

Baclofen for chronic hiccups.

Chronic hiccups is a rare occurrence but can be debilitating for the patient. Successful intervention is seldom reported. The present case is a young adult who had severe almost continuous hiccups for 3 years after placement of a feeding gastrostomy and Nissen fundoplication. Within weeks of initiation of baclofen treatment, the hiccups ceased. Recurrences of hiccups have responded to increases in baclofen dosage.

Adolescent↗
PubMed1992

[Chronic hiccups].

We report 18 cases of chronic hiccup (defined as lasting for more than 48 hours) in adults. Among the numerous possible causes, reflux esophagitis proved to be by far the most frequent (50% of the cases). However, hiccup often initiated a self-perpetuating vicious circle. This is possibly because hiccup per se can give esophageal dyskinesia, which in turn leads to gastro-esophageal reflux. The treatment was difficult and whenever possible has been directed chiefly towards the cause. However hiccup remained intractable in many cases even after a possible cause had been adequately cured (e.g., successful Nissen procedure in reflux cases). Central nervous system depressants and myorelaxing drugs were not very helpful, except for baclofen (initial response rate = 60%).

Adult↗
PubMed1979

Hiccups: an unusual manifestation of an abdominal aortic aneurysm.

A patient with hiccups was found to have an abdominal aortic aneurysm that subsequently ruptured. We believe that a leaking abdominal aortic aneurysm led to an ileus-induced distention of the splenic flexure of the colon with consequent diaphragmatic irritation and phrenic nerve stimulation. This led to persistent hiccups as a result of repetitive stimulation of the reflex arc mediating hiccups. Persistent hiccups require investigation for an underlying organic etiology, and a leaking abdominal aortic aneurysm should be included in the differential diagnosis.

Aged↗
PubMed1998

Baclofen, a treatment for chronic hiccup.

The efficacy of baclofen in the treatment of chronic hiccup is demonstrated in two cases. These cases highlight the present state of knowledge related to hiccup. This discussion focuses on the definition and classification of hiccup, etiologies, postulated theories to explain its function, the few studies performed to date, and non-pharmacologic and pharmacologic treatment. Baclofen appears to be the agent most efficacious in the treatment of chronic hiccup. Its commonest side effect is sedation; insomnia, dizziness, weakness, ataxia, and confusion also can occur. Following regular use, abrupt discontinuation can lead to withdrawal symptoms, such as seizure, and gradual discontinuation is recommended.

Aged↗
PubMed1980

Possible termination of ventricular bigeminy by hiccups.

Although hiccups may increase vagal discharges by modulating changes in respiratory stretch receptors or atrial filling, it is more likely that a hiccup-induced Valsalva maneuver was responsible for abolishing ventricular bigeminy in our patient. This would explain the delay that was shown on the ECG between the occurrence of the hiccup artifacts and the termination of the extrasystoles. The patient's critical condition prevented our determining the effect of altering parasympathetic activity, but our observations led us to believe that the relationship between the occurrence of hiccups and the disappearance of ventricular extrasystoles was more than coincidental.

Arrhythmias, Cardiac↗