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Alimentary Pharmacology & Therapeutics Nov 2015Hiccups are familiar to everyone, but remain poorly understood. Acute hiccups can often be terminated by physical manoeuvres. In contrast, persistent and intractable... (Review)
Review
BACKGROUND
Hiccups are familiar to everyone, but remain poorly understood. Acute hiccups can often be terminated by physical manoeuvres. In contrast, persistent and intractable hiccups that continue for days or months are rare, but can be distressing and difficult to treat.
AIM
To review the management of hiccups, including a systematic review of reported efficacy and safety of pharmacological treatments.
METHODS
Available articles were identified using three electronic databases in addition to hand searching of published articles. Inclusion criteria were any reports of pharmaceutical therapy of 'hiccup(s)', 'hiccough(s)' or 'singultus' in English or German.
RESULTS
Treatment of 341 patients with persistent or intractable hiccups was reported in 15 published studies. Management was most effective when directed at the underlying condition. An empirical trial of anti-reflux therapy may be appropriate. If the underlying cause is not known or not treatable, then a range of pharmacological agents may provide benefit; however, systematic review revealed no adequately powered, well-designed trials of treatment. The use of baclofen and metoclopramide are supported by small randomised, placebo-controlled trials. Observational data suggest that gabapentin and chlorpromazine are also effective. Baclofen and gabapentin are less likely than standard neuroleptic agents to cause side effects during long-term therapy.
CONCLUSIONS
This systematic review revealed no high quality data on which to base treatment recommendations. Based on limited efficacy and safety data, baclofen and gabapentin may be considered as first line therapy for persistent and intractable hiccups, with metoclopramide and chlorpromazine in reserve.
Topics: Amines; Anticonvulsants; Antipsychotic Agents; Baclofen; Benzamides; Chlorpromazine; Cyclohexanecarboxylic Acids; GABA-B Receptor Agonists; Gabapentin; Hiccup; Humans; Metoclopramide; Randomized Controlled Trials as Topic; Treatment Outcome; gamma-Aminobutyric Acid
PubMed: 26307025
DOI: 10.1111/apt.13374 -
SpringerPlus 2016Hiccups are the sudden involuntary contractions of the diaphragm and intercostal muscles. They are generally benign and self-limited, however, in some cases they are... (Review)
Review
Hiccups are the sudden involuntary contractions of the diaphragm and intercostal muscles. They are generally benign and self-limited, however, in some cases they are chronic and debilitating. There are approximately 4000 admissions for hiccups each year in the United States. The hiccup reflex arc is composed of three components: (1) an afferent limb including the phrenic, vagus, and sympathetic nerves, (2) the central processing unit in the midbrain, and (3) the efferent limb carrying motor fibers to the diaphragm and intercostal muscles. Hiccups may be idiopathic, organic, psychogenic, or medication-induced. Data obtained largely from case studies of hiccups either induced by or treated with medications have led to hypotheses on the neurotransmitters involved. The central neurotransmitters implicated in hiccups include GABA, dopamine, and serotonin, while the peripheral neurotransmitters are epinephrine, norepinephrine, acetylcholine, and histamine. Further studies are needed to characterize the nature of neurotransmitters at each anatomical level of the reflex arc to better target hiccups pharmacologically.
PubMed: 27588250
DOI: 10.1186/s40064-016-3034-3 -
Tidsskrift For Den Norske Laegeforening... Jan 2024Persistent hiccups lasting more than 48 hours are rare and have numerous possible causes that require further investigation.
BACKGROUND
Persistent hiccups lasting more than 48 hours are rare and have numerous possible causes that require further investigation.
CASE PRESENTATION
We present a man in his seventies who was admitted to hospital after 11 days of hiccups. The hiccups were preceded by abdominal pain that spontaneously receded after a few hours. At admission he had no abdominal pain during examination, but a CT scan later suggested that the cause was a perforated cholecystitis with an intra-abdominal abscess. The abscess was drained percutaneously and treated with antibiotics, and the hiccups stopped.
INTERPRETATION
Persistent hiccups warrant thorough examination, and it is recommended to consider CT scans of the head and truncus, cerebral MRI scan and an upper GI endoscopy. Treating the underlying cause of hiccups is the ultimate target, while symptomatic treatment simultaneously is preferred.
Topics: Humans; Male; Abdominal Pain; Anti-Bacterial Agents; Cholecystitis; Hiccup; Hospitalization; Aged
PubMed: 38258722
DOI: 10.4045/tidsskr.23.0437 -
Frontiers in Neuroscience 2020The use of dopamine receptor blockers for chronic singultus treatment is based-at least partially-on circular thinking: chlorpromazine is FDA-approved for hiccups,... (Review)
Review
The use of dopamine receptor blockers for chronic singultus treatment is based-at least partially-on circular thinking: chlorpromazine is FDA-approved for hiccups, chlorpromazine is a neuroleptic, neuroleptics are dopamine receptor blockers, and therefore hiccup is due to dopaminergic dysfunction. Chlorpromazine interacts with high affinity with a multitude of receptors and ion channels. This promiscuity is the basis for many of the therapeutic effects and adverse drug reactions of this drug. While an involvement of dopamine is certain, it is by no means clear that dopaminergic dysfunction is the hallmark of singultus. The common denominator of most remedies for transient hiccup is their ability to activate the vagus nerve. Both afferent and efferent vagal activity and the central integration of the Xth cranial nerve function are modulated, inter alia, via serotonergic mechanisms; beneficial (therapeutic) effects for hiccup are to be expected from serotonin (5-HT) receptor subtype ligands that enhance vagal activity. Taken together, it appears that the ability to increase vagus output is mainly associated with 5-HT, 5-HT, and 5-HT agonists and with 5-HT antagonists. The plausibility of the serotonergic singultus hypothesis is examined against available pharmacokinetic, pharmacodynamic, and clinical data for a number of drugs.
PubMed: 32765206
DOI: 10.3389/fnins.2020.00629 -
The Libyan Journal of Medicine Dec 2023Central hiccups following a stroke are a frequent complication, exerting adverse effects on both the stroke condition and the patient's daily life. Existing treatments... (Meta-Analysis)
Meta-Analysis Review
Central hiccups following a stroke are a frequent complication, exerting adverse effects on both the stroke condition and the patient's daily life. Existing treatments exhibit limited efficacy and pronounced side effects. Acupuncture has been explored as a supplementary intervention in clinical practice. This study aims to investigate the clinical effectiveness of acupuncture for post-stroke hiccups. To identify published clinical randomized controlled trials addressing post-stroke hiccups treatment, comprehensive searches were conducted across PubMed, the Cochrane Library, EMBASE, Web of Science, Chinese Biological Medical (CBM), Wanfang Database, and China Science and Technology Journal (VIP). In addition, we scrutinized ClinicalTrials.gov and the Chinese Clinical Trial Registry. Employing Cochrane Handbook 5.1.0 and Review Manager 5.4 software, three authors independently reviewed literature, extracted data, and evaluated study quality. Data analysis was performed using Stata 16.0 and Review Manager 5.4. A total of 18 trials were encompassed in the analysis. In comparison to standard treatment, acupuncture exhibited a significant enhancement in treatment effectiveness (RR: 1.27, 95% CI: 1.21-1.33; < 0.00001). Notably, Hiccup Symptom Score displayed a considerable decrease (WMD: -1.28, 95% CI: -1.64 to -0.93; < 0.00001), concurrent with a noteworthy improvement in the quality of life (WMD: 8.470, 95% CI: 7.323-9.617; < 0.00001). Additionally, the incidence of adverse reactions decreased (RR: 0.45, 95% CI: 0.16-1.25; = 0.13), and there was a significant reduction in SAS (WMD: -7.23, 95% CI: -8.47 - -5.99; < 0.00001). Our investigation suggests that acupuncture could prove effective in post-stroke hiccup treatment. Nonetheless, due to concerns about the quality and size of the included studies, conducting higher-quality randomized controlled trials to validate their efficacy is imperative.
Topics: Humans; Hiccup; Quality of Life; Acupuncture Therapy; China
PubMed: 37644765
DOI: 10.1080/19932820.2023.2251640 -
Brain and Behavior Nov 2019The main culprit lesion causing hiccup in patients with ischemic stroke is thought to involve the medulla oblongata, but some cases of hiccups caused by damage to the...
BACKGROUNDS
The main culprit lesion causing hiccup in patients with ischemic stroke is thought to involve the medulla oblongata, but some cases of hiccups caused by damage to the supratentorial cortex have been reported. The present study aimed to address the clinical and radiological characteristics of acute stroke patients accompanied by hiccups caused by supratentorial lesions.
METHOD
We retrospectively studied 5,309 consecutive patients with acute ischemic stroke or transient ischemic attack who were admitted to our institute within 7 days after onset between April 2006 and September 2017. We searched for the term "hiccup" in prospectively collected descriptive datasets and analyzed associations between hiccup and clinical and radiological findings, with particular focus on patients with supratentorial lesions.
RESULTS
We finally selected 16 stroke patients accompanied by hiccup. Nine patients had infarcts in the lateral medulla oblongata, and others had supratentorial infarcts (three patients with cortical infarcts, four patients with subcortical infarcts). Moreover, the right hemisphere was frequently damaged in this series (6/7, 86%).
CONCLUSIONS
Hiccup could be caused by supratentorial infarcts including the insular cortex, temporal lobe, and subcortex.
Topics: Aged; Aged, 80 and over; Cerebral Cortex; Cerebral Infarction; Hiccup; Humans; Male; Medulla Oblongata; Middle Aged; Retrospective Studies; Temporal Lobe
PubMed: 31617326
DOI: 10.1002/brb3.1439 -
Canadian Medical Association Journal Jul 1934
PubMed: 20319568
DOI: No ID Found -
Case Reports in Anesthesiology 2020Hiccups are a common and poorly understood pathologic phenomenon. While hiccups often occur suddenly and episodically, they may persist for weeks and sometimes months....
Hiccups are a common and poorly understood pathologic phenomenon. While hiccups often occur suddenly and episodically, they may persist for weeks and sometimes months. There is a paucity of data regarding the precise etiology and optimal treatment for persistent hiccups. Frequently considered a benign and frustrating condition, hiccups are sometimes a presenting symptom for pulmonary embolism and cardiac disease. We present a patient with gastroesophageal reflux disease who developed 11 days of recurrent hiccups following an orthopedic procedure.
PubMed: 32695523
DOI: 10.1155/2020/8867431 -
Revue Medicale de Liege Mar 2022Hiccups are most often benign and of short duration. However, they may also be persistent (superior to 48h) or even refractory (superior to 1 month). In such cases, they...
Hiccups are most often benign and of short duration. However, they may also be persistent (superior to 48h) or even refractory (superior to 1 month). In such cases, they markedly alter the quality of life and can lead to severe impairment of health. We here review hiccups pathophysiology, etiologies, work up and treatment. We suggest that hiccups should be considered as a non-epileptic myoclonic movement disorder.
Topics: Hiccup; Humans; Quality of Life
PubMed: 35258864
DOI: No ID Found