Hiccups in disease

Although it is rare, intractable hiccups may be a sign of disease and cause problems of their own, such as difficulty eating, weight loss, dehydration and poor sleep. There are even very rare reports of hiccups contributing to death. The most famous is that of Pope Pius XII in 1958, whose death was widely reported to be related to intractable hiccups. However, he apparently suffered from recurrent gastritis, which itself could have provoked persistent or intractable hiccups, and he ultimately died of strokes and pneumonia. The world record for hiccups (according to Guinness) is held by a farmer from Iowa who apparently hiccupped for more than 60 years for no known reason. When hiccups develop after major surgery, each hiccup may cause significant pain and can impair wound healing.

When hiccups are associated with medical problems, the cause is usually irritation of one of the nerves in the chest. Examples include laryngitis, goiters (enlargement of the thyroid gland), tumors in the neck, infections near the diaphragm, and hiatus hernia (usually with gastro-esophageal reflux disease (GERD). Hiccups can also be triggered by excess alcohol use, kidney failure, and other infections (especially ear infections). Rarer causes are aortic aneurysms and multiple sclerosis.

Treating a disorder that may be triggering hiccups is usually the first course of action for prolonged or intractable hiccups. For example, surgical removal of a tumor, medication treatment for GERD (such as cimetidine or omeprazole) or antibiotic treatment of an infection may reduce or even eliminate severe hiccups when one of those conditions is the trigger.

Myth or not?

Although there is much we don't understand about hiccups and how to make them stop, this much seems to be true:

  • Hiccups are not a reliable sign of alcohol use.
  • Holding one’s breath, breathing into a bag, being frightened, swallowing sugar, or drinking from the opposite side of a glass may be effective (though scientific proof is lacking). Other maneuvers that may work (and seem reasonably safe) include biting on a lemon, pulling on the tongue, gargling ice water or “tickling” the hard palate with a cotton swab. Knowing just how effective each of these may be and how much is myth is difficult because they are advocated primarily for “benign” hiccups that would likely resolve on their own regardless of treatment.
  • Medications can reduce hiccups. Among those with scientific evidence of effectiveness are chlorpromazine, metoclopramide, and baclofen (although side effects may be limiting). A variety of other medications have been suggested, though unproven. These include anticonvulsants (such as phenytoin), antidepressants (such as amitriptyline) and even marijuana.
  • Certain drugs are thought to cause hiccups. Discontinuing these medicines can an effective cure. Examples include midazolam (a relative of ValiumR), some types of chemotherapy, and digoxin (a heart medication).
  • Other approaches with rare reports of effectiveness for intractable hiccups include hypnosis, acupuncture, and even surgery. Two examples of surgical procedures are a “nerve block” that stops the phrenic nerve (the major nerve supply for the diaphragm) from sending signals so that the diaphragm stops contracting, and implantation of a pacemaker that results in more rhythmic contractions of the diaphragm.
  • Hiccups may be dangerous, but that’s rare. As mentioned above, weight loss, poor wound healing and even death occasionally have been attributed to intractable hiccups.

The bottom line

Hiccups are a normal and common human experience (though shared by many animals as well). They may serve an important purpose, although what that could be remains unknown. The next time you are afflicted with hiccups and everyone around you is giving you different advice, you may be better off politely walking away; chances are excellent that your hiccups will soon pass no matter what you do. And while others may think you’ve been drinking just because you have the hiccups, let them know that’s a common misconception—unless, of course, it’s true.

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