Ask the Doctors by Eve Glazier, M.D. and Elizabeth Ko, M.D

Persistent Hiccups Could Be Indication of Something Serious

Dear Doctor: My husband frequently has hiccups, and sometimes they last for days. What causes them? Is there any way to make them stop?

Dear Reader: Hiccups are due to a sudden and involuntary contraction of the diaphragm. That’s the dome-shaped structure that separates the thoracic cavity, also known as the chest cavity, from the abdominal cavity. The diaphragm, which is made up of muscle and membranes, serves both as the floor of the thoracic cavity and the roof of the abdominal cavity. Its motion is responsible for your ability to inhale and exhale. The diaphragm also plays a propulsive role in sneezing, coughing, crying, vomiting and eliminating feces and urine.

When you’re breathing normally, the diaphragm contracts and flattens out, moving downward in a smooth motion as you inhale. The lungs expand into the added space, which allows air to enter. The exhale occurs when the diaphragm returns to its natural domed shape, which crowds the supple lung tissues and forces the air out. When something causes the diaphragm to flatten suddenly in a convulsive motion, the resulting inward rush of air causes the structures at the top of the windpipe, including the vocal cords, to snap shut. This makes the distinctive “hic” sounds that gives the hiccups their name.

You can get the hiccups for no apparent reason. They are also associated with common triggers such as eating too much or too quickly; foods that are hot or spicy; fizzy beverages; alcohol; smoking; and emotional extremes, like stress, fear, or getting excited and laughing. In most cases, hiccups will clear up on their own, as quickly and mysteriously as they appeared.

When they last for more than a few days, or even a few weeks, they are known as persistent hiccups. When the condition lasts for more than a month, which is rare, they are referred to as intractable, or chronic, hiccups. For reasons that are not fully understood, these are more common in men than in women. Charles Osborne, a farmer in Iowa, had the hiccups for 68 years, a fact that earned him a spot in the Guinness Book of World Records.

Persistent hiccups are associated with irritation or damage to the phrenic or vagus nerves, which travel to the diaphragm. These can include growths in the neck, such as a cyst or tumor; gastroesophageal reflux disease, or GERD; or even just a sore throat. They have also been associated with serious conditions, such as kidney disease, diabetes, multiple sclerosis and stroke. For some people, general anesthesia during surgery can cause the onset of persistent hiccups.

Prolonged hiccups can interfere with eating, sleeping and quality of life. It would be a good idea for your husband to check with your family doctor for a diagnosis. Blood, imaging or endoscopic tests may be used to see if an underlying medical condition is causing the episodes. Treatment can include certain medications, including muscle relaxants, sedatives or anticonvulsants. Some patients report success with acupuncture or hypnosis. In the most severe cases, surgery can be an option, but potential complications can be severe.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)