Intractable Hiccups: More Common Than We Think? | Loyola Medicine
Thursday, July 26, 2018

Intractable Hiccups May Be More Common Than We Think

MAYWOOD, IL – Everyone gets hiccups, but some people suffer intractable hiccups that last longer than a month, according to two Loyola Medicine neurologists.

"Intractable hiccups can occur more often than we realize and present to multiple medical disciplines," Stasia Rouse, MD, and Matthew Wodziak, MD, wrote in the journal Current Neurology and Neuroscience Reports. Dr. Rouse is chief neurology resident and Dr. Wodziak is an assistant professor in Loyola's department of neurology.

Hiccups typically occur between four and 60 times a minute. Acute hiccups are common. They start without any specific reason and go away in a few minutes. They often can be stopped by holding the breath or breathing into a paper bag.

Persistent hiccups (lasting longer than two days) and intractable hiccups (lasting longer than a month) generally are associated with underlying medical conditions. They interfere with eating, socializing and sleeping and can significantly impair a patient's quality of life. The longest recorded case was an Iowa farmer who hiccupped continually for 69 years and nine months, according to the Guinness Book of World Records.

About 4,000 people in the United States are hospitalized each year for hiccups. Ninety-one percent of people who suffer intractable hiccups are men, most of whom are over age 50.

Drs. Rouse and Wodziak describe a hiccup as an involuntary, spasmodic contraction of the diaphragm and sometimes the intercostal muscles (tiny muscles between the ribs). This causes inhalation to be cut short by closure of the glottis (the opening between the vocal chords).

Common hiccup triggers are drinking carbonated drinks or eating a large meal. Anxiety or stress also can trigger hiccups, along with alcohol, spices, smoking or other irritants to the gastrointestinal or respiratory tracts.

Intractable hiccups usually have underlying causes. In one patient, for example, hiccups were traced to arthritis in the sternoclavicular joint (the joint connecting the collar bone to the breast bone). In another patient, hiccups were linked to pulmonary embolisms (blood clots in the lungs). Certain drugs also can trigger hiccups.

In addition to treating the underlying cause, if known, physicians can treat hiccups with various medications, including baclofen, gabapentin, metoclopramide, chlorpromazine and haloperidol, Drs. Rouse and Wodziak wrote. Nerve blocks within or near the phrenic nerve (involved in breathing) also are being studied. Other reported remedies include swallowing granulated sugar, hypnosis and acupuncture.

Hiccup treatments cross multiple disciplines, including neurology, gastroenterology, pulmonology and primary care, Drs. Rouse and Wodziak wrote. There are no formal guidelines for treating intractable hiccups. Many treatments are founded merely on a physician's own experience or anecdotal evidence.

"There is a lack of good quality evidence to recommend specific treatment for hiccups," Drs. Rouse and Wodziak wrote.

Their paper is titled "Intractable Hiccups."

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 94 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 133,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.