Hiccups

Hiccups are a sudden and involuntary reflex contraction of the diaphragm. Diaphragm is a muscle right under the ribcage and helps control the breathing action.
In normal cases, hiccups last for a short period of few minutes with a frequency of 4 to 60 in a minute. These have no specific purpose and disappear on its own and do not require any treatment. These affect men and women equally.
There can be rare cases of hiccups lasting 48 hours to beyond a month. These longer period hiccups are classified as below:
Protracted or persistent hiccups – which last between 2days to a month
Intractable hiccups – which last more than a month.
These longer period hiccups more commonly occur in men and is indicative of a causal condition or problem. It affects intake of water and food and can be extremely bothering and

Causes

A sudden and involuntary contraction in the diaphragm causes the person to breathe in air very fast which is interrupted by closing of the glottis or the space between the vocal cords, making the distinctive hiccup sound.
Short-term hiccups have no particular reason to arise. One experiences these short-lived hiccups one in a while and it is absolutely normal to get them. Most often these come up after alcohol intake or on a bloated belly, last for a few minutes and disappear without any need for treatment.
Intractable or Persistent hiccups which carry on for more than 48 hours are sure to have underlying factors and need to be addressed more seriously by investigating the condition or problem causing it. There are times, when even investigations become futile and the causes do not get diagnosed.
Some of the conditions which can become causal factors for long-term hiccups are outlined below:

• Tumours
• Pneumonia or swelling in the lungs
• Obstruction in the small bowel
• Gastritis or swelling in the stomach
• Heart attack or stroke
• Pericarditis or heart tissue inflammation
• Addison’s disease: disorder that causes deficiency in hormone production.
• Goitre or inflammation of the thyroid gland
• Multiple sclerosis or condition wherein the immune system of the body starts to go against the nervous system.
• Gastroesophageal reflux disease (GORD) – flowing of stomach acid into the oesophagus
• Metabolic imbalances like hyperglycaemia or high blood sugar.
• Anorexia nervosa
• Other serious general infections.
• Persistent hiccups get triggered by certain drug reactions to tranquillizers like benzodiazepines or anti-inflammatory medications like corticosteroids.
• Anaesthetics
• Persistent hiccups can also be caused by psychological or emotional factors like grief, anxiety or excitement.

Diagnosis

If hiccups persist longer than 48 hours, one should contact the GP. The GP will discuss medical and health history and do a physical body examination to get down to the underlying cause of any problem or condition that might be responsible for the long-term hiccups.
The GP might advise certain tests related to the blood to investigate on various possible causal conditions and to identify any malfunction in any of the organs of the body.
If needed, you might also be asked to go for an ECG or electrocardiogram to rule out pericarditis.
A chest X-ray might be done to examine if there is any inflammation in the lungs causing the hiccups.

Treatment

Most often, hiccups are short-term and do not need any medical attention or treatment as they discontinue on their own.
However, certain self-care factors can help resolve condition faster. These include chewing on a piece of lemon, having chilled water, taking sugar, having a sip of vinegar, holding breath momentarily, pulling knees to the chest or bending ahead to press the chest.
In cases of persistent and intractable hiccups, if the GP diagnoses the underlying problem or disorder causing hiccups, it is important to treat the causal factor as soon as possible to prevent hiccups from going on further.
The GP might refer you to the concerned specialist, if required or else if suitable he will recommend medication to stop hiccups. The medications include baclofen, gabapentin, metoclopramide, haloperidol and chlorpromazine and are prescribed depending on individual conditions of patients, their age and general medical health. In some cases, medicines might act fast and get hiccups under control within a week without any further repeated bouts. In other cases, the medication might have to be used for longer time with varied dosages to see what is most effective for the individual patient
Medications are used only if no underlying causal factor is identified or the other treatment fails to resolve the hiccups.
In case a child experiences long-term hiccups, they need to see a specialist or health professional before prescribing any medication.
Till date, not enough research has been carried out on the efficacy of these medications.