Alexander K. C. Leung*, Amy A.M. Leung, Alex H.C. Wong and Kam Lun Hon Pages 1 - 8 ( 8 )
Background: Hiccups are a universal phenomenon. They are usually benign and self-limited. Persistent or intractable hiccups, although rare, can be debilitating and may indicate the presence of an underlying pathological process.
Objective: To familiarize physicians with the pathophysiology, etiology, evaluation, and management of children with hiccups.
Methods: A search was conducted on December 10, 2019 in Pubmed Clinical Queries using the key terms "hiccup" OR “hiccough” OR “singultus”. The selected publication types included all clinical trials (including open trials, non-randomized controlled trials, and randomized controlled trials), observational studies, and reviews (including meta-analysis and narrative reviews) published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article.
Results: Overdistension of the stomach is the most commonly identifiable cause of acute hiccups, followed by gastroesophageal reflux and gastritis. Other causes of hiccups, notably persistent and intractable hiccups, include an underlying gastrointestinal, neurological, cardiovascular, pulmonary, infectious, and psychogenic disorder. Persistent or intractable hiccups can be a harbinger of serious medical pathology. A detailed history and thorough physical examination may provide clues for the etiology of the hiccups. The treatment of hiccups should be directed at the underlying cause whenever possible. Bouts of acute hiccups less than 48 hours rarely require medical intervention as they usually resolve within minutes. Treatment may be considered when hiccups are bothersome, persistent, or intractable. Treatment modalities include lifestyle changes, physical maneuvers, pharmacotherapy, and very rarely, surgical intervention.
Conclusion: Acute hiccups are usually benign and self-limiting. Persistent or intractable hiccups can be a harbinger of serious medical pathology. The underlying cause should be treated if possible. There are no formal guidelines to the treatment of hiccups. Currently, most of the methods proposed are based on case reports and anecdotal evidence. Terminating an episode of hiccups can be very challenging for a clinician but may tremendously improve the patient’s quality of life. It is hoped that future well-designed and better-powered studies will provide us with more information on the efficacy of various treatment modalities for hiccups.
gastric overdistension, hiccough, phrenic nerve, singultus, sympathetic nerves, vagal nerve
Department of Pediatrics, The University of Calgary and The Alberta Children’s Hospital, Calgary, Alberta, Department of Family Medicine, The University of Alberta, Edmonton, Alberta, Department of Family Medicine, The University of Calgary, Calgary, Alberta, Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital