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Noda S, Yamaguchi J, Kosugi K, Ishida A, Harada M, Ishizuka K, Inoue Y, Kubo E, Miura T. Peppermint Inhalation Therapy for Persistent Hiccups in Terminally Ill Cancer Patient: A Case Study. J Pain Symptom Manage 2024; 67:e503-e505. [PMID: 38331234 DOI: 10.1016/j.jpainsymman.2024.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/23/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Affiliation(s)
- Sakiho Noda
- Department of Palliative Medicine (S.N., J.Y., K.K., A.I., M.H., K.I., Y.I., E.K. and T.M.), National Cancer Center Hospital East, Kashiwa, Japan
| | - Junji Yamaguchi
- Department of Palliative Medicine (S.N., J.Y., K.K., A.I., M.H., K.I., Y.I., E.K. and T.M.), National Cancer Center Hospital East, Kashiwa, Japan
| | - Kazuhiro Kosugi
- Department of Palliative Medicine (S.N., J.Y., K.K., A.I., M.H., K.I., Y.I., E.K. and T.M.), National Cancer Center Hospital East, Kashiwa, Japan
| | - Ayaka Ishida
- Department of Palliative Medicine (S.N., J.Y., K.K., A.I., M.H., K.I., Y.I., E.K. and T.M.), National Cancer Center Hospital East, Kashiwa, Japan
| | - Mariko Harada
- Department of Palliative Medicine (S.N., J.Y., K.K., A.I., M.H., K.I., Y.I., E.K. and T.M.), National Cancer Center Hospital East, Kashiwa, Japan
| | - Keisuke Ishizuka
- Department of Palliative Medicine (S.N., J.Y., K.K., A.I., M.H., K.I., Y.I., E.K. and T.M.), National Cancer Center Hospital East, Kashiwa, Japan
| | - Yujiro Inoue
- Department of Palliative Medicine (S.N., J.Y., K.K., A.I., M.H., K.I., Y.I., E.K. and T.M.), National Cancer Center Hospital East, Kashiwa, Japan
| | - Emi Kubo
- Department of Palliative Medicine (S.N., J.Y., K.K., A.I., M.H., K.I., Y.I., E.K. and T.M.), National Cancer Center Hospital East, Kashiwa, Japan
| | - Tomofumi Miura
- Department of Palliative Medicine (S.N., J.Y., K.K., A.I., M.H., K.I., Y.I., E.K. and T.M.), National Cancer Center Hospital East, Kashiwa, Japan; Division of Biomarker Discovery (T.M.), Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Hospital East, Kashiwa, Japan.
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Butt E, Zamora E, Shabot JM. An Unusual Cause of Intractable Hiccups. ACG Case Rep J 2023; 10:e01073. [PMID: 37312753 PMCID: PMC10259643 DOI: 10.14309/crj.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/11/2023] [Indexed: 06/15/2023] Open
Abstract
Hiccups are a minor nuisance for most people and usually resolve within minutes. However, for some, they can persist for years and result in severe symptoms and even death. This case report describes a patient found to have a mediastinal lipoma resulting in intractable hiccups. The discussion highlights the pathophysiology, etiologies, and treatments of hiccups.
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Affiliation(s)
- Edward Butt
- Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Ernesto Zamora
- Department of Gastroenterology and Hepatology, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - J. Marc Shabot
- Department of Gastroenterology and Hepatology, The University of Texas Medical Branch at Galveston, Galveston, TX
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Shivkumar V, Nemade D, Dhingra N. Persistent hiccups following thalamic hemorrhage: A case report. Heliyon 2023; 9:e16409. [PMID: 37274664 PMCID: PMC10238684 DOI: 10.1016/j.heliyon.2023.e16409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/24/2023] [Accepted: 05/16/2023] [Indexed: 06/06/2023] Open
Abstract
Persistent hiccups (lasting more than 48 hours) can cause physical and emotional distress. They can result in dehydration, exhaustion, malnutrition, insomnia, wound dehiscence, ventilatory desynchronization, and hemodynamic changes. Hiccups are thought to be due to a complex reflex arc involving peripheral nerves and central structures such as the brainstem, temporal lobe, basal ganglia, hypothalamus, and spinal cord levels C3-5. Medullary strokes, for instance, have been reported to cause hiccups. We report a patient with a thalamic bleed who developed persistent hiccups. A 56-year-old man was brought to the hospital in an unresponsive state. He was intubated for airway protection. CT brain showed a left thalamic hemorrhage with edema and mass effect on the 3rd ventricle, intraventricular extension of hemorrhage, and hydrocephalus. An external ventricular drain was placed successfully with adequate drainage. One week after admission, the patient developed persistent abdominal jerks. These jerks were occurring every 3-4 seconds and would last for hours with brief periods of remission. He was started on levetiracetam 1000 mg IV bid and then increased to 1500 mg IV BID without any improvement of symptoms. The patient was also placed on EEG which did not reveal any epileptiform abnormality but did show an EMG artifact. His electrolytes including sodium, and potassium, and corrected calcium levels were normal. He did not have any evidence of pneumonia or other infections. It was determined that these jerks were likely hiccups. Metoclopramide 10 mg IV was tried without any benefit. He was then started on Baclofen 10 mg PO TID which resulted in a significant improvement in hiccups. Our case suggests that thalamic lesions might also lead to persistent hiccups.
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Alshammary SA, Al Fraihat LAS, Farahat YH, Alshehri A, Almustanyir S. Successful Treatment of Persistent Hiccups in an Advanced Palliative Cancer Patient With Gabapentin: A Case Report. Cureus 2023; 15:e36982. [PMID: 37139273 PMCID: PMC10149886 DOI: 10.7759/cureus.36982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 04/04/2023] Open
Abstract
Hiccups may appear to be a common normal phenomenon that does not warrant treatment in the general population. However, severe and persistent hiccups can become annoying and distressing and may decrease the quality of life, especially in cancer patients. The management of hiccups remains challenging. Despite trying many pharmacological and non-pharmacological methods, there is no clear evidence to support the management guidelines. In our case, we successfully treated persistent hiccups of more than four days duration in a patient with acute myeloblastic leukemia with gabapentin.
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Zhang N, Liang H, Wang X, Wang H. Fatal posterior circulation stroke with persistent hiccups, sinus arrest and post-hiccup syncope: A case report. Medicine (Baltimore) 2023; 102:e33053. [PMID: 36800607 PMCID: PMC9936028 DOI: 10.1097/md.0000000000033053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
RATIONALE Diagnosis of posterior circulation stoke is difficult, and magnetic resonance imaging especially diffusion-weighted imaging is superior to computed tomography. Persistent hiccups, sinus arrest, and post-hiccup syncope are extremely rare symptoms of posterior circulation stroke. However, there is no effective treatment for persistent hiccup. PATIENT CONCERN AND DIAGNOSIS We describe a case of a 58-year-old hypertensive woman diagnosed with acute posterior circulation stroke who presented with persistent hiccups, sinus arrest, and post-hiccup syncope. Diffusion-weighted imaging revealed a high-intensity signal involving the left middle cerebellar peduncle and several spotted areas in the right occipital lobe. INTERVENTIONS Permanent pacemaker was implanted and metoclopramide was used to treat persistent hiccups. OUTCOME The patient developed aspiration pneumonia and morbid dysphoria, and eventually died. LESSONS Posterior circulation stroke can cause cardiovascular and respiratory dysfunction. Consequently, physicians should pay more attention to posterior circulation lesions in patients with arrhythmia and syncope. An effective method to treat persistent hiccups is urgently needed.
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Affiliation(s)
- Na Zhang
- Department of Cardiology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei Province, China
| | - Hao Liang
- Department of Cardiology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei Province, China
| | - Xibing Wang
- Department of Cardiology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei Province, China
| | - Hong Wang
- Department of Cardiology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei Province, China
- * Correspondence: Hong Wang, Department of Cardiology, Affiliated Hospital of Chengde Medical University, No. 36 Nanyingzi Street, Shuangqiao District, Chengde 067000, Hebei Province, China (e-mail: )
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Sawamura T, Karashima S, Ohmori A, Sawada K, Aono D, Kometani M, Takeda Y, Yoneda T. Hiccups as the first presentation of secondary adrenal insufficiency associated with advanced cervical cancer. Endocrinol Diabetes Metab Case Rep 2022; 2022:22-0286. [PMID: 36017819 PMCID: PMC9422230 DOI: 10.1530/edm-22-0286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 07/21/2022] [Indexed: 11/30/2022] Open
Abstract
Summary Hiccups are a common symptom characterized by intermittent spasmodic contraction of the diaphragm. Most hiccups are transient, but some are refractory. Patients with intractable hiccups often have abnormalities of the diaphragm, medulla oblongata, and lesions affecting nerve fibers connecting them. Moreover, electrolyte abnormalities, including hyponatremia, are frequently observed in patients with intractable hiccups. Adrenal insufficiency (AI) is one of the causes of hyponatremia. However, hiccups are not commonly the first presentation. Herein, we describe a case of a 45-year-old woman complaining of refractory hiccups. The patient was initially diagnosed with hiccups associated with cervical cancer metastasis to the liver and peritoneum. The administration of chlorpromazine did not have a beneficial effect on her hiccup. Fasting hypoglycemia and hyponatremia were later found. Her serum cortisol level was low without an elevation of adrenocorticotropic hormone level. MRI of the pituitary gland showed metastatic lesion in the pituitary gland and stalk. Thus, the patient was diagnosed with secondary AI due to cervical cancer metastasis to the pituitary gland and stalk. Administration of hydrocortisone improved her hiccups with the normalization of serum sodium level. Therefore, differential diagnosis in advanced cancer patients with hiccups should include AI-induced hyponatremia. Learning points Hiccups could be the first manifestation of adrenal insufficiency (AI). Hiccups in patients with AI are often mediated by hyponatremia. Hyponatremia is less frequent in secondary AI than in primary AI. However, hyponatremia can result from increased antidiuretic hormone due to loss of cortisol. The differential diagnosis should include AI-induced hyponatremia if hiccups occur in patients with advanced cancer, as metastasis to adrenal gland or pituitary gland could cause AI.
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Affiliation(s)
- Toshitaka Sawamura
- Department of Internal Medicine, Asanogawa General Hospital, Kanazawa, Ishikawa, Japan
- Department of Endocrinology and Metabolism, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, Japan
| | - Shigehiro Karashima
- Department of Health Promotion and Medicine of the Future, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Ai Ohmori
- Department of Internal Medicine, Asanogawa General Hospital, Kanazawa, Ishikawa, Japan
- Department of Endocrinology and Metabolism, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, Japan
| | - Kei Sawada
- Department of Internal Medicine, Asanogawa General Hospital, Kanazawa, Ishikawa, Japan
| | - Daisuke Aono
- Department of Endocrinology and Metabolism, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, Japan
- Department of Health Promotion and Medicine of the Future, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Mitsuhiro Kometani
- Department of Endocrinology and Metabolism, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, Japan
- Department of Health Promotion and Medicine of the Future, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yoshiyu Takeda
- Department of Internal Medicine, Asanogawa General Hospital, Kanazawa, Ishikawa, Japan
| | - Takashi Yoneda
- Department of Endocrinology and Metabolism, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, Japan
- Department of Health Promotion and Medicine of the Future, Kanazawa University, Kanazawa, Ishikawa, Japan
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Hiccups in patients with cancer: a multi-site, single-institution study of etiology, severity, complications, interventions, and outcomes. BMC Cancer 2022; 22:659. [PMID: 35705907 PMCID: PMC9202213 DOI: 10.1186/s12885-022-09760-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background To our knowledge, previous studies have not investigated hiccups in patients with cancer with detailed patient-level data with the goal of capturing a broad spectrum of hiccup symptomatology. Methods This multi-site, single institution study examined consecutive medical records to better understand hiccups in patients with cancer. Results A total of 320 patients are the focus of this report. The median age of patients when hiccups were first reported in the medical record was 63 years (range: 21, 97 years) with 284 (89%) men and 36 (11%) women. The most common diagnose was gastrointestinal cancer. Hiccups most frequently occurred daily, as seen in 194 patients (62%), and the most common duration was less than 1 week, as seen in 146 patients (47%). However, nine patients had had daily hiccups for greater than 6 weeks, and 5 had symptoms for years. Cited etiology was non-chemotherapy medications in 36 (11%) and cancer chemotherapy in 19 (6%). Complications occurred in approximately a third and included insomnia in 51 patients (16%); hospitalization or emergency department visit in 34 (11%); and musculoskeletal pain in 23 (7%). Baclofen was the single most prescribed agent for hiccup palliation, but 100 patients received more than one medication. Medical procedures, which included acupuncture, paracentesis, or phrenic nerve block, were performed in 5 patients. In 234 patients (73%), the medical record documented hiccup cessation. Conclusions Hiccups appear to be highly problematic in a small subset of patients with cancer with no well-defined palliative approaches.
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Ehret CJ, Jatoi A. Establishing the Groundwork for Clinical Trials With Hiccupops ® for Hiccup Palliation. Am J Hosp Palliat Care 2022; 39:1210-1214. [PMID: 34985350 DOI: 10.1177/10499091211063821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Because hiccup palliation remains an unmet clinical need, we report here on an early experience with Hiccupops, ® a patented product designed for the express purpose of providing a mechanism-based intervention for hiccup palliation. METHODS Meter Health, the developer and manufacturer of this patented product, used a purposive sampling approach to allow individuals with hiccups and a desire for hiccup palliation to purchase their agent and then to report on its efficacy or lack thereof. The authors of this report were provided these outcome data and allowed to analyze, report, and publish with no input from Meter Health with the exception of comments on accuracy. RESULTS This report focused on 43 surveys that were completed. In response to the question, "Did the Hiccupops work for the person they were purchased for?" 29 (67%) responded, "yes." Seven individuals (16%) responded, "no;" and 7 (16%) were "not sure." Write-in comments appeared to substantiate the effective palliative nature of the intervention: "A friend with 10 days of hiccups following… brain tumor surgery, after 2 days, they stopped!!!#." Another noted the following: "I like that if my hiccups get painful they're there as a quick relief." Less favorable comments were also noted: "She couldn't get past the…. taste." Another read as follows: "They were not effective in stopping my father's intractable hiccups…. I like that there is someone out there who cares about trying to stop people's hiccups." CONCLUSIONS This patented product appears to palliate hiccups in some individuals and merits further study.
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Affiliation(s)
| | - Aminah Jatoi
- Department of Oncology, 6915Mayo Clinic, Rochester, MN, USA
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Talwar D, Kumar S, Acharya S, Madaan S, Hulkoti V. Intractable Hiccups in a Young Male: Is it a Tell-Tale Sign of Pseudocyst of Pancreas? Cureus 2021; 13:e17951. [PMID: 34660139 PMCID: PMC8514800 DOI: 10.7759/cureus.17951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 11/05/2022] Open
Abstract
Although encountered routinely in the outpatient department, hiccups or singultus are mostly neglected by the clinicians owing to its benign presentation and self-limiting nature. However, an innocent-looking symptom such as a hiccup can be a warning sign of serious underlying medical conditions and hence should be addressed seriously. Hiccups can seriously alter the quality of life and induce anxiety when they become intractable. We present an atypical case of a 30-year-old male who presented with intractable hiccups for four months and upon investigations revealed to be a case of chronic pancreatitis with pseudocyst of the pancreas. The patient's intractable hiccups were not responding to metoclopramide and responded well to gabapentin. The patient was managed conservatively for chronic pancreatitis and pseudocyst of the pancreas. This case report highlights the importance of investigating the cause of a simple symptom like hiccup as it can be a tell-tale sign of a chronic underlying pathology such as pseudocyst of the pancreas in our case. After an extensive review of literature, it was found that this is the first case to report intractable singultus as a result of the pseudocyst of the pancreas.
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Affiliation(s)
- Dhruv Talwar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, IND
| | - Sunil Kumar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science (Deemed to be University), Wardha, IND
| | - Sourya Acharya
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, IND
| | - Sparsh Madaan
- Obstetrics and Gynaecology, Datta Meghe Institute of Medical Science (Deemed to be University), Jawaharlal Nehru Medical College, Wardha, IND
| | - Vidyashree Hulkoti
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science (Deemed to be University), Wardha, IND
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Ergen M, Arikan F, Fırat Çetin R. Hiccups in Cancer Patients Receiving Chemotherapy: A Cross-Sectional Study. J Pain Symptom Manage 2021; 62:e85-e90. [PMID: 33587996 DOI: 10.1016/j.jpainsymman.2021.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 11/30/2022]
Abstract
CONTEXT Hiccups are a symptom in cancer patients but it's less researched. OBJECTIVES The aimed to determine of prevalence of hiccups and treatment approach used in hiccup management in cancer patients receiving chemotherapy for nursing care. METHODS This study used a descriptive cross-sectional design with self-reported questionnaires and was conducted from November 2018-May 2019 in Turkey. For collection of the data, a Patient Information Form (sociodemographic and disease characteristics), and a Hiccups Evaluation Form were used for the patients. RESULTS Hiccups were observed in 37 (23%) of the 160 patients who met the criteria for inclusion in the study. The great majority of the patients suffering from hiccups were male (65.9%) and the type of cancer in the majority of these patients was gastrointestinal cancer (54.1%). It was determined that the duration of hiccups in 83.8% of patients observed with hiccups was between 0 and 48 hours, that the average severity of their hiccups was 3.81 ± 2.25 (0-10), and that hiccups in 59.5% of these patients was of low severity. It was found that only 10.8% of patients suffering from hiccups used pharmacological methods for relief and that 27% used nonpharmacological methods. CONCLUSION The results of the study showed that over one-fifth of cancer patients suffered from hiccups. This situation reveals that hiccups are an important symptom that needs to be carefully emphasised in oncology practice.
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Affiliation(s)
- Mevlüde Ergen
- Department of Medical Oncology, Memorial Hospital, Antalya, Turkey
| | - Fatma Arikan
- Faculty of Nursing, Akdeniz University, Antalya, Turkey.
| | - Rüya Fırat Çetin
- Department of Medical Oncology, Memorial Hospital, Antalya, Turkey
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Protracted Hiccups Induced by Aripiprazole and Regressed after Administration of Gabapentin. Case Rep Psychiatry 2021; 2021:5567152. [PMID: 33976948 PMCID: PMC8084681 DOI: 10.1155/2021/5567152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/17/2022] Open
Abstract
Hiccups are sudden, repeated, and involuntary contractions of the diaphragm muscle (myoclonic contraction). It involves a reflex arc that, once activated, causes a strong contraction of the diaphragm immediately followed by the closure of the glottis translating into the classic "hic" sound. Hiccups can be short, persistent, and intractable depending on the duration. The most disabling hiccups often represent the epiphenomenon of a medical condition such as gastrointestinal and cardiovascular disorders; central nervous system (CNS) abnormalities; ear, nose, and throat (ENT) conditions or pneumological problems; metabolic/endocrine disorders; infections; and psychogenic disorders. Some drugs, such as aripiprazole, a second-generation antipsychotic, can induce the onset of variable hiccups. We describe herein the cases of three hospitalized patients who developed insistent hiccups after taking aripiprazole and who positively responded to low doses of gabapentin. It is probable that aripiprazole, prescribed at a low dosage (<7.5 mg/day), would act as a dopamine agonist by stimulating D2 and D3 receptors at the "hiccup center" level-located in the brain stem-thus triggering the hiccup. On the other hand, gabapentin led to a complete regression of the hiccup probably by reducing the nerve impulse transmission and modulating the diaphragmatic activity. The present case series suggests the use of low doses of gabapentin as an effective treatment for aripiprazole-induced hiccups. However, our knowledge of the neurotransmitter functioning of the hiccup reflex arc is still limited, and further research is needed to characterize the neurotransmitters involved in hiccups for potential novel therapeutic targets.
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Kamoshida S, Okauchi S, Osawa H, Ohara G, Kagohashi K, Satoh H. Effect of Shakuyakukanzoto on Chemotherapy-Induced Hiccups in Patients with Lung Cancer. Eurasian J Med 2021; 53:2-4. [PMID: 33716521 DOI: 10.5152/eurasianjmed.2020.18184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/25/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Shakuyakukanzoto, one of the traditional herbal medicines commonly used in North-East Asian countries, is known to be effective for muscle cramps. This retrospective study aimed to evaluate the effect of shakuyakukanzoto on chemotherapy-induced metoclopramide-uncontrolled hiccups. Materials and Methods We retrospectively investigated the medical records of all the consecutive patients with lung cancer who were prescribed with shakuyakukanzoto (Tsumura Co. Tokyo, Japan) for chemotherapy-induced hiccups in our hospital from September 2013 to November 2017. In the medical record from the initiation of shakuyakukanzoto until the start of the next chemotherapy, when there was description of "complete or partial disappearance of hiccups" after the prescription of shakuyakukanzoto, it was judged as a complete or partial response. A statement of "unchanged," no description of improvement, or exacerbation was judged as no change. Results Of the 49 chemotherapy courses in 15 patients with lung cancer, 93.9% had a "partial or complete" response within a few hours after the administration of shakuyakukanzoto. The effect of shakuyakukanzoto was observed irrespective of the pathological type of lung cancer, platinum-containing or non-platinum chemotherapy, and with or without other anti-hiccup drugs. No adverse event was observed. Conclusion Shakuyakukanzoto may offer an effective pharmacological approach to treat chemotherapy-induced metoclopramide-uncontrolled hiccups. Well-planned prospective studies will confirm our results.
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Affiliation(s)
- Satoshi Kamoshida
- Department of Pharmacy, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Ibaraki, Japan
| | - Shinichiro Okauchi
- Department of Respiratory Medicine, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Ibaraki, Japan
| | - Hajime Osawa
- Department of Respiratory Medicine, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Ibaraki, Japan
| | - Gen Ohara
- Department of Respiratory Medicine, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Ibaraki, Japan
| | - Katsunori Kagohashi
- Department of Respiratory Medicine, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Ibaraki, Japan
| | - Hiroaki Satoh
- Department of Respiratory Medicine, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Ibaraki, Japan
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Egbu E, Ihemedu C, Eze UA, Nwajei C, Ikponmwosa M. Steroid-Induced Hiccups in a Patient Managed for Pseudo Foster-Kennedy Syndrome: A Case Report of Good Outcome With the use of Gabapentin. Cureus 2021; 13:e12893. [PMID: 33643737 PMCID: PMC7903257 DOI: 10.7759/cureus.12893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The use of IV methylprednisolone has been shown to be associated with some adverse effects. The most feared side effect is acute gastrointestinal perforation and accelerated hypertension particularly during pulse therapy. Hiccups occur less frequently but can cause high levels of discomfort to the patient. In intractable cases, respiratory arrest and death can occur. This article reports the occurrence of hiccups in a patient managed for pseudo Foster-Kennedy syndrome. The hiccups were observed shortly after IV methylprednisolone was administered to the patient and abetted over a period of one week after it was discontinued. Hiccups occur through the neuronal pathway of the hiccup reflex arc, comprising the vagus nerve, phrenic nerve, parts of the sympathetic nervous system (T6-T12), and efferent fibers from the phrenic nerve that supply the glottis and the accessory muscles of respiration. The hiccups resolved with the use of gabapentin. This case report aims to add to the existing body of knowledge of the efficacy of gabapentin in the management of hiccups.
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Affiliation(s)
- Ejike Egbu
- Ophthalmology, Lily Hospitals Limited, Warri, NGA
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Persistent Postoperative Hiccups. Case Rep Anesthesiol 2020; 2020:8867431. [PMID: 32695523 PMCID: PMC7355363 DOI: 10.1155/2020/8867431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/29/2020] [Accepted: 06/04/2020] [Indexed: 01/16/2023] Open
Abstract
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.
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Reichenbach ZW, Piech GM, Malik Z. Chronic Hiccups. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2020; 18:43-59. [PMID: 31974814 DOI: 10.1007/s11938-020-00273-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Nearly 4000 patients will be admitted to hospital in the US this year for hiccups. Hiccups are controlled by a complex reflex arc between peripheral receptors and the brainstem. Any disruption along this pathway may produce hiccups. Typically, hiccups resolve spontaneously but in certain pathologies symptoms may persist. Persistent hiccups may be considered a sign of underlying pathology. The most common cause involves GERD. RECENT FINDINGS Based on etiologies, studies have shown that first-line therapy should use a proton pump inhibitor (PPI) and involve appropriate gastrointestinal consultation. If symptoms persist, other etiologies such as central causes need to be explored. SUMMARY We review the pathophysiology of hiccups including multiple causes and the appropriate work up for each. We review several studies examining new treatments, both pharmacological and interventional, that may help patients. Initial therapy should still involve a PPI but several new therapies may be beneficial.
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Affiliation(s)
- Zachary Wilmer Reichenbach
- Department of Gastroenterology, Lewis Katz School of Medicine at Temple University Hospital, 3401 N. Broad St., 8th floor Parkinson Pavilion, Philadelphia, PA, 19140, USA
- Center for Substance Abuse Research (CSAR), Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Gregory M Piech
- Department of Gastroenterology, Lewis Katz School of Medicine at Temple University Hospital, 3401 N. Broad St., 8th floor Parkinson Pavilion, Philadelphia, PA, 19140, USA
| | - Zubair Malik
- Department of Gastroenterology, Lewis Katz School of Medicine at Temple University Hospital, 3401 N. Broad St., 8th floor Parkinson Pavilion, Philadelphia, PA, 19140, USA.
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Adam E. A Systematic Review of the Effectiveness of Oral Baclofen in the Management of Hiccups in Adult Palliative Care Patients. J Pain Palliat Care Pharmacother 2020; 34:43-54. [DOI: 10.1080/15360288.2019.1705457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Emily Adam
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Kings College London, London, UK
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Lee AR, Cho YW, Lee JM, Shin YJ, Han IS, Lee HK. Treatment of persistent postoperative hiccups with stellate ganglion block: Three case reports. Medicine (Baltimore) 2018; 97:e13370. [PMID: 30508930 PMCID: PMC6283092 DOI: 10.1097/md.0000000000013370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Although persistent postoperative hiccups can cause various problems (such as sleep disorders, depression, fatigue) for the patient, there has been little research on this topic. The purpose of this study is to determine the effectiveness of treating persistent postoperative hiccups with a stellate ganglion block (SGB), an injection of local anesthetic in the sympathetic nerve tissue of the neck. PATIENT CONCERNS AND DIAGNOSES Three patients each developed persistent hiccups within 3 days of abdominal surgery, lasting for 3 to 6 days. The patients were diagnosed as having persistent hiccups based on the hiccup duration. INTERVENTIONS AND OUTCOMES The 3 patients were treated with an SGB. After the procedure, the frequency and intensity of hiccups decreased and then the hiccups stopped completely. CONCLUSION An SGB is an effective method that can be considered in conjunction with other treatments for persistent hiccups. Clinicians should be mindful of the negative effects that persistent hiccups can exert on patients.
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Abstract
Background In a previous article we reported the time that hiccups stop as the instant when CO2 levels in both expiratory gas (EtCO2) and inspiratory gas (InspCO2) reach approximately 50 mmHg. To support our findings, in this article we aim to clarify the precise values of the CO2 level in arterial blood (PaCO2) and venous blood (PvCO2) during plastic bag rebreathing. Methods A healthy male volunteer was asked to perform a rebreathing experiment using a 20 L air-filled plastic bag. During the experiment, his blood oxygen saturation level (SpO2), EtCO2 and InspCO2 were measured until the volunteer gave up. PaCO2 and PvCO2 were measured at the following four points: P0, when the rebreathing started; P1, when both EtCO2 and InspCO2 indicated the same value; P2, when both reached 50 mmHg; and P3, when SpO2 dropped to 90%. Results InspCO2 increased from the beginning and showed the same value as EtCO2 at P1. PaCO2 at P1 was almost the same value as both InspCO2 and EtCO2. After P1, InspCO2, EtCO2 and PaCO2 increased at the same rate, and at P2, they reached the level of PvCO2. After P2, all four markers continued to show the same value as they gradually increased. Conclusions Creating conditions inside the body in which PaCO2 increases to the same level as PvCO2 will stop hiccups consistently. Although other physiological pathways to stop hiccups may exist, for a successful outcome it is important that the balance of power between the cerebellum and the medulla is drastically altered.
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Affiliation(s)
- Toshiro Obuchi
- Department of Thoracic Surgery, St. Mary's Hospital, Kurume, Japan
| | - Jun-Ichi Wakahara
- Department of Thoracic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Naoyuki Fujimura
- Department of Anesthesiology, St. Mary's Hospital, Kurume, Japan
| | - Akinori Iwasaki
- Department of Thoracic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Pharmacologic Interventions for Intractable and Persistent Hiccups: A Systematic Review. J Emerg Med 2018; 53:540-549. [PMID: 29079070 DOI: 10.1016/j.jemermed.2017.05.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/26/2017] [Accepted: 05/30/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Chlorpromazine is the only drug approved by the US Food and Drug Administration for the treatment of hiccups; however, many other pharmacologic treatments have been proposed for intractable and persistent hiccups. Currently, there is little evidence to support the use of one agent over another. OBJECTIVE This review aims to identify literature concerning the use of pharmacologic treatments for intractable and persistent hiccups with the goal of evaluating therapies in terms of their level of evidence, mechanism of action, efficacy, dosing, onset of action, and adverse effects. METHODS A systematic literature search of PubMed, Embase, the Cochrane Library, and the New York Academy of Medicine was performed to find articles where a pharmacologic agent was used to treat intractable or persistent hiccups between the years 1966 and 2016. The GRADE method was used to assess the level of evidence for the studies included in this review. RESULTS This review identified 26 articles involving 10 pharmacologic treatment options that met our inclusion criteria. Amitriptyline, baclofen, gabapentin, haloperidol, metoclopramide, midazolam, nifedipine, nimodipine, orphenadrine, and valproic acid were found in the literature to be successful in treating hiccups. CONCLUSION Baclofen, gabapentin, and metoclopramide were the only agents that were studied in a prospective manner, while only baclofen and metoclopramide were studied in randomized controlled trials. No specific recommendations can be made for treating intractable and persistent hiccups with the evidence currently available in the literature. Therapy selection should be specific to individual patients, their underlying comorbidities, etiology of hiccups, and take into account the individual properties of the drugs.
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Yoon JR, Ko YD, Yun SI, Chung ME. Phrenic Nerve Clipping in a Stroke Patient with Intractable Hiccup: a Case Report. BRAIN & NEUROREHABILITATION 2018. [DOI: 10.12786/bn.2018.11.e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jung Ro Yoon
- Department of Rehabilitation Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yun Dam Ko
- Department of Rehabilitation Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo In Yun
- Department of Rehabilitation Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myung Eun Chung
- Department of Rehabilitation Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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22
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Kako J, Kobayashi M, Kanno Y, Tagami K. Intranasal Vinegar as an Effective Treatment for Persistent Hiccups in a Patient With Advanced Cancer Undergoing Palliative Care. J Pain Symptom Manage 2017; 54:e2-e4. [PMID: 28438587 DOI: 10.1016/j.jpainsymman.2017.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 02/20/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Jun Kako
- Department of Nursing, National Cancer Center Hospital East, Chiba, Japan; Section of Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | | | - Yusuke Kanno
- Department of Palliative Nursing, Health Sciences, Graduate School of Medicine, Tohoku University, Miyagi, Japan; Division of Psycho-Oncology, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center Hospital, Chiba, Japan
| | - Keita Tagami
- Department of Palliative Medicine, National Cancer Center Hospital East, Chiba, Japan
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Persistent Singultus Associated with Lumbar Epidural Steroid Injections in a Septuagenarian: A Case Report and Review. Am J Phys Med Rehabil 2017; 96:e1-e4. [PMID: 27149594 DOI: 10.1097/phm.0000000000000526] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Singultus are rare but notable adverse effect of epidural steroid injections (ESIs). To date, reports of persistent hiccups associated with ESIs have been reported mostly in adults aged 65 years or older. We present the first case of persistent hiccups in a septuagenarian who underwent repeated transforaminal ESIs for chronic lumbar radiculopathy. Under fluoroscopic guidance, 1.5 mL of 1% lidocaine (preservative free) and 0.8 mL of dexamethasone solution (10 mg/mL) was injected into the bilateral L4-L5 neural foramen and epidural space.After the first epidural injection, episodes of singultus occurred at a frequency of 5 to 7 episodes per minute and lasted for 36 hours. One month later, he was treated with the second epidural injection after which he immediately developed singultus, occurring at 2- to 3-hour intervals. Interventions for the singultus included drinking small sips of water, vagal maneuvers, and oropharyngeal stimulation with ice chips. The singultus eventually resolved without medical intervention within 5 days of onset. A major take-home point is that preprocedure informed consent should include singultus as one of the potential adverse effects of ESIs. Increased awareness and appropriate planning may help curb the incidence of adverse outcomes in older adults undergoing ESI.
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Jeon YS, Kearney AM, Baker PG. Management of hiccups in palliative care patients. BMJ Support Palliat Care 2017; 8:1-6. [DOI: 10.1136/bmjspcare-2016-001264] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 06/11/2017] [Accepted: 06/26/2017] [Indexed: 11/03/2022]
Abstract
Persistent hiccups are a frustrating experience for palliative care patients, and can have a profound impact on their quality of life. This article provides an evidence-based approach overview of the causes and treatment of this not infrequently debilitating condition for such patients, with a management algorithm. In situations where no readily reversible cause is identified, or where simple physical manoeuvres, such as breath holding have failed, a systematic approach is required. Hiccups can be broadly divided into central and peripheral types. These respond differently to pharmacological intervention. The drug of choice for central causes of persistent hiccups is baclofen, with metoclopramide recommended as the first choice for peripheral causes. Midazolam may be useful in cases of terminal illness. Interventional procedures such as vagal or phrenic nerve block or stimulation should be considered in patients who are refractory to medications. The management of persistent hiccups still presents an ongoing clinical challenge however, requiring further research on pathophysiology and treatment strategies. Multinational randomised controlled trials to evaluate and compare both current and new medications or procedures to better manage this difficult condition are suggested as a means of reaching this goal.
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25
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Nausheen F, Mohsin H, Lakhan SE. Neurotransmitters in hiccups. SPRINGERPLUS 2016; 5:1357. [PMID: 27588250 PMCID: PMC4988959 DOI: 10.1186/s40064-016-3034-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 08/10/2016] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Fauzia Nausheen
- Department of Medical Education, California University of Science and Medicine - School of Medicine, 1405 W. Valley Blvd, Suite 101, Colton, CA 92343 USA
| | - Hina Mohsin
- Department of Neurology, California University of Science and Medicine - School of Medicine, Colton, CA USA
| | - Shaheen E Lakhan
- Department of Medical Education, California University of Science and Medicine - School of Medicine, 1405 W. Valley Blvd, Suite 101, Colton, CA 92343 USA ; Department of Neurology, California University of Science and Medicine - School of Medicine, Colton, CA USA
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26
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Hernandez SL, Fasnacht KS, Sheyner I, King JM, Stewart JT. Treatment of Refractory Hiccups with Amantadine. J Pain Palliat Care Pharmacother 2015; 29:374-7. [DOI: 10.3109/15360288.2015.1101640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Steger M, Schneemann M, Fox M. Systemic review: the pathogenesis and pharmacological treatment of hiccups. Aliment Pharmacol Ther 2015; 42:1037-50. [PMID: 26307025 DOI: 10.1111/apt.13374] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 04/26/2015] [Accepted: 07/28/2015] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- M Steger
- Division of Internal Medicine, University Hospital Zürich, Zürich, Switzerland
| | - M Schneemann
- Division of Internal Medicine, University Hospital Zürich, Zürich, Switzerland
| | - M Fox
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.,Zürich Center for Integrated Human Physiology, Zürich, Switzerland
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Gonella S, Gonella F. Use of vinegar to relieve persistent hiccups in an advanced cancer patient. J Palliat Med 2015; 18:467-70. [PMID: 25775370 DOI: 10.1089/jpm.2014.0391] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This case report describes a patient whose persistent hiccups significantly improved with the use of vinegar. CASE PRESENTATION A patient with an adenocarcinoma of the colon and hepatic metastases developed hiccups the day following chemotherapy with FOL-FOX (folinic acid (leucovorin), 5-fluorouracil, oxaliplatin). Hiccups continued for seven days with no improvement from a number of commonly used pharmacological agents (chlorpromazine, metoclopramide, haloperidol, and baclofen). Relief was finally obtained after sipping vinegar. CASE MANAGEMENT AND OUTCOME: Hiccups occurred several times during the following chemotherapy cycles but the patient completed the treatment using vinegar when they recurred without stopping any drugs. Hiccups stopped or decreased in intensity or in rate per minute after sipping vinegar. CONCLUSIONS Hypotheses have been developed for the molecular and physiological mechanisms underlying sour compounds' effectiveness in relieving hiccups. Further studies should explore the potential role of vinegar in relieving hiccups in advanced heavily treated cancer patients.
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Affiliation(s)
- Silvia Gonella
- 1 Department of Public Health and Community Medicine, University of Verona , Verona, Italy
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29
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Shinde S, Gordon P, Sharma P, Gross J, Davis MP. Use of non-opioid analgesics as adjuvants to opioid analgesia for cancer pain management in an inpatient palliative unit: does this improve pain control and reduce opioid requirements? Support Care Cancer 2014; 23:695-703. [PMID: 25168780 DOI: 10.1007/s00520-014-2415-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 08/18/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cancer pain is complex, and despite the introduction of the WHO cancer pain ladder, few studies have looked at the prevalence of adjuvant medication use in an inpatient palliative medicine unit. In this study, we evaluate the use of adjuvant pain medications in patients admitted to an inpatient palliative care unit and whether their use affects pain scores or opiate dosing. METHODS In this retrospective observational study, patients admitted to the inpatient palliative care unit over a 3-month period with a diagnosis of cancer on opioid therapy were selected. Data pertaining to demographics, diagnosis, oral morphine dose equivalent of the opioid at the time of discharge, adjuvant analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), and pain scores as reported by nurses and physicians were collected. RESULTS Seventy-seven patients were eligible over a 3-month period, out of which 65 (84 %) were taking an adjuvant medication. The most commonly prescribed adjuvant was gabapentin (70 %). Fifty-seven percent were taking more than one adjuvant. There were more women in the group receiving adjuvants (57 vs. 17%, p = 0.010). Those without adjuvants compared with those on adjuvants did not have worse pain scores on discharge as reported by physicians (0.8 ± 0.8 vs. 1.0 ± 0.7, p = 0.58) or nurses (2.0 ± 2.7 vs. 2.1 ± 2.6, p = 0.86). There was no difference in morphine equivalent doses of the opioid in both groups (median (min, max); 112 (58, 504) vs. 200 (30, 5,040)) at the time of discharge; 75-80 % of patients had improvement in pain scores as measured by a two-point reduction in numerical rating scale (NRS). DISCUSSION This study shows that adjuvant medications are commonly used for treating pain in patients with cancer. More than half of study population were on two adjuvants or an adjuvant plus NSAID along with an opioid. We did not demonstrate any benefit in terms of improved pain scores or opioid doses with adjuvants, but this could reflect confounding variables and physician choice. Larger prospective studies are needed to define the opioid-sparing effects of adjuvants. CONCLUSION Adjuvant agents are used in over 80 % of those treated for cancer pain.
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Affiliation(s)
- Shivani Shinde
- The Harry R Horvitz Center for Palliative Medicine, Division of Solid Tumor, Cleveland Clinic Taussig Cancer Institute, 9500 Euclid Avenue, R35, Cleveland, OH, 44195, USA
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Thompson AN, Ehret Leal J, Brzezinski WA. Olanzapine and Baclofen for the Treatment of Intractable Hiccups. Pharmacotherapy 2013; 34:e4-8. [DOI: 10.1002/phar.1378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Amy N. Thompson
- Department of Clinical Pharmacy and Outcome Sciences; South Carolina College of Pharmacy; Medical University of South Carolina; Charleston South Carolina
| | - Julie Ehret Leal
- Clinical Pharmacy Specialist in Ambulatory Care; Department of Pharmacy Services; Medical University of South Carolina; Charleston South Carolina
| | - Walter A. Brzezinski
- College of Medicine; Medical University of South Carolina; Charleston South Carolina
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Abstract
OBJECTIVE: To determine whether gabapentin is effective in the treatment of persistent or intractable hiccups. DATA SOURCES: A search of MEDLINE (1966-March 2013) using the MeSH search terms gabapentin, hiccups, and hiccups/drug therapy was performed. Additional databases searched included Web of Science (1945-March 2013) and International Pharmaceutical Abstracts (1970-March 2013) using the text words gabapentin and hiccups. Bibliographies of relevant articles were reviewed for additional citations. STUDY SELECTION AND DATA EXTRACTION: All data sources were considered for inclusion. Preference was given for articles written in English, although one abstract in German was used. DATA SYNTHESIS: Because of the low incidence of persistent or intractable hiccups, few if any controlled clinical trials are conducted on the efficacy of drug treatment. Therefore, most of the data involve case reports or case series. We evaluated 17 case reports and 2 case series involving gabapentin therapy for persistent or intractable hiccups. Therapeutic outcomes with gabapentin were positive in all cases, with temporal evidence suggesting an effect, but outcomes often were obscured by combination therapy and comorbidities in some cases. Case reports suggest that gabapentin might be useful as a second-line agent in patients undergoing stroke rehabilitation or in the palliative care setting where chlorpromazine adverse effects are undesirable. Gabapentin was very well tolerated, with only a few minor adverse effects. CONCLUSIONS: Gabapentin has a similar body of evidence as other pharmacotherapeutic agents used to treat hiccups. Gabapentin is well tolerated and should be considered as a second-line agent in selected patients.
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Affiliation(s)
- Dennis F Thompson
- Dennis F Thompson PharmD FASHP FCCP, Dean and Nelson M. Sims Endowed Chair, College of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK
| | - Krista G Brooks
- Krista G Brooks PharmD, Assistant Professor of Pharmacy Practice, Southwestern Oklahoma State University
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Rizzo C, Vitale C, Montagnini M. Management of intractable hiccups: an illustrative case and review. Am J Hosp Palliat Care 2013; 31:220-4. [PMID: 23408373 DOI: 10.1177/1049909113476916] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Often thought of as a benign and self-limited condition, hiccups can become persistent or intractable, and thus be associated with substantial morbidity and distress. In such cases, an underlying etiology is often present, and may be overlooked. Debilitating hiccups can present a major challenge to optimal symptom management. Various causes of protracted hiccups have been identified including metabolic abnormalities, central nervous system pathology, malignancy, medications, and disorders attributed to cardiac, pulmonary and gastrointestinal etiologies. We present a case of intractable hiccups in a patient with an advanced hematological malignancy and review specific therapies for the management of persistent hiccups.
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Affiliation(s)
- Camielle Rizzo
- 1Division of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
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33
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Moretto EN, Wee B, Wiffen PJ, Murchison AG. Interventions for treating persistent and intractable hiccups in adults. Cochrane Database Syst Rev 2013; 2013:CD008768. [PMID: 23440833 PMCID: PMC6452787 DOI: 10.1002/14651858.cd008768.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Persistent and intractable hiccups (typically defined as lasting for more than 48 hours and one month respectively) can be of serious detriment to a patient's quality of life, although they are relatively uncommon. A wide range of pharmacological and non-pharmacological interventions have been used for the treatment of persistent and intractable hiccups. However, there is little evidence as to which interventions are effective or harmful. OBJECTIVES The objective of this review was to evaluate the effectiveness of pharmacological and non-pharmacological interventions used in the treatment of persistent and intractable hiccups of any aetiology in adults. SEARCH METHODS Studies were identified from the following databases: CENTRAL, CDSR, DARE, MEDLINE, EMBASE, CINAHL, PsychINFO and SIGLE (last search March 2012). The search strategy for all the databases searched was based on the MEDLINE search strategy presented in Appendix 1. No additional handsearching of journals was undertaken. Investigators who are known to be carrying out research in this area were contacted for unpublished data or knowledge of the grey literature. SELECTION CRITERIA Studies eligible for inclusion in this review were randomised controlled trials (RCTs) or controlled clinical trials (CCTs). INCLUSION CRITERIA adults (over 18 years old) diagnosed with persistent or intractable hiccups (hiccups lasting more than 48 hours), treated with any pharmacological or non-pharmacological intervention. EXCLUSION CRITERIA less than ten participants; no assessment of change in hiccup frequency or intensity in outcome measures. DATA COLLECTION AND ANALYSIS Two independent review authors assessed each abstract and title for relevance. Disagreement on eligibility was resolved by discussion. Where no abstract was available the full paper was obtained and assessed. We obtained full copies of the studies which met the inclusion criteria for further assessment. Two review authors independently collected data from each appropriate study and entered them into the software Review Manager 5. Two independent review authors assessed the risk of bias using the RevMan 5 'Risk of bias' table following guidance from the Cochrane Handbook of Systematic Reviews of Interventions (Higgins 2009). MAIN RESULTS A total of four studies (305 participants) met the inclusion criteria. All of these studies sought to determine the effectiveness of different acupuncture techniques in the treatment of persistent and intractable hiccups. All four studies had a high risk of bias, did not compare the intervention with placebo, and failed to report side effects or adverse events for either the treatment or control groups. Due to methodological differences we were unable to perform a meta-analysis of the results. No studies investigating pharmacological interventions for persistent and intractable hiccups met the inclusion criteria. AUTHORS' CONCLUSIONS There is insufficient evidence to guide the treatment of persistent or intractable hiccups with either pharmacological or non-pharmacological interventions.The paucity of high quality studies indicate a need for randomised placebo-controlled trials of both pharmacological and non-pharmacological treatments. As the symptom is relatively rare, trials would need to be multi-centred and possibly multi-national.
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Alix JJ, Ponnusamy A, Bhattacharyya D, Hoggard N, Grünewald RA. Complex partial seizures: Going out with a hiccup. Seizure 2012; 21:820-2. [DOI: 10.1016/j.seizure.2012.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 08/31/2012] [Accepted: 09/02/2012] [Indexed: 10/27/2022] Open
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Menon M. Gabapentin in the treatment of persistent hiccups in advanced malignancy. Indian J Palliat Care 2012; 18:138-40. [PMID: 23093831 PMCID: PMC3477368 DOI: 10.4103/0973-1075.100839] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Hiccups are a distressing symptom in advanced malignancies in the setting of palliative care. A case of persistent hiccups treated with oral Gabapentin is presented to highlight the clinical and ethical dilemmas in patients with advanced malignancy. A 70-year-old male with non-small cell cancer of the lung with widespread metastases presented with persistent hiccups. The patient and family sought only symptom relief from home, without hospitalization or further investigations. The hiccups were dramatically relieved by oral Gabapentin, highlighting the recent reports that mention this molecule as being useful for hiccups. Gabapentin is a simple tool that may be utilized by palliative care physicians to relieve hiccups in advanced malignancies.
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Affiliation(s)
- Mahesh Menon
- Department of Pain Medicine and Palliative Care Services, Kokilaben Dhirubhai Ambani Hospital, Four bungalows, Andheri (West), Mumbai-53, India
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Calsina-Berna A, García-Gómez G, González-Barboteo J, Porta-Sales J. Treatment of Chronic Hiccups in Cancer Patients: A Systematic Review. J Palliat Med 2012; 15:1142-50. [DOI: 10.1089/jpm.2012.0087] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Agnès Calsina-Berna
- Palliative Care Service, Institut Català d'Oncologia, Universitari de Bellvitge Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Palliative Care Research Group, Bellvitge Biomedical Research Institute, Universitari de Bellvitge Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- San Diego Hospice, Institute for Palliative Medicine, San Diego, California
| | | | - Jesús González-Barboteo
- Palliative Care Service, Institut Català d'Oncologia, Universitari de Bellvitge Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Palliative Care Research Group, Bellvitge Biomedical Research Institute, Universitari de Bellvitge Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Porta-Sales
- Palliative Care Service, Institut Català d'Oncologia, Universitari de Bellvitge Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Palliative Care Research Group, Bellvitge Biomedical Research Institute, Universitari de Bellvitge Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
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Chang FY, Lu CL. Hiccup: mystery, nature and treatment. J Neurogastroenterol Motil 2012; 18:123-30. [PMID: 22523721 PMCID: PMC3325297 DOI: 10.5056/jnm.2012.18.2.123] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 02/01/2012] [Accepted: 02/10/2012] [Indexed: 11/20/2022] Open
Abstract
Hiccup is the sudden onset of erratic diaphragmatic and intercostal muscle contraction and immediately followed by laryngeal closure. The abrupt air rush into lungs elicits a "hic" sound. Hiccup is usually a self-limited disorder; however, when it is prolonged beyond 48 hours, it is considered persistent whereas episodes longer than 2 months are called intractable. A reflex arc involving peripheral phrenic, vagal and sympathetic pathways and central midbrain modulation is likely responsible for hiccup. Accordingly, any irritant in terms of physical/chemical factors, inflammation, neoplasia invading the arc leads to hiccups. The central causes of hiccup include stroke, space occupying lesions and injury etc, whereas peripheral causes include lesions along the arc such as tumors, myocardial ischemia, herpes infection, gastroesophageal reflux disease and applied instrumentations on human body etc. Besides, various drugs (eg, anti-parkinsonism drugs, anesthetic agents, steroids and chemotherapies etc) are the possible etiology. An effective treatment of persistent hiccup may be established upon the correct diagnosis of lesion responsible for the serious event. The pharmacotherapy of hiccup includes chlorpromazine, gabapentin, baclofen, serotonergic agonists, prokinetics and lidocaine. Non-pharmacological approaches such as nerve blockade, pacing, acupuncture and measures to hold breathing are also successful. Finally, alternative medicines and remedies are convenient to treat hiccups with uncertain effect. In conclusions, hiccup is likely to result from lesions involving the hiccup reflex arc. The lesion may need to be localized correctly for ablative treatment in patients with intractable hiccup. Apart from lesion ablation, drugs acting on reflex arc may be effective, while some other conventional measures may also be tried.
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Affiliation(s)
- Full-Young Chang
- Environmental Health and Safety Office, Division of Gastroenterology, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan
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Page RL, Luna M, Brieke A, Lindenfeld J. Low-dose gabapentin for intractable hiccups in a heart transplant recipient. Prog Transplant 2011. [DOI: 10.7182/prtr.21.4.06j346401831527q] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Robert L Page
- University of Colorado, School of Pharmacy, Aurora, CO 80045, USA.
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Page RL, Luna M, Brieke A, Lindenfeld J. Low-dose Gabapentin for Intractable Hiccups in a Heart Transplant Recipient. Prog Transplant 2011; 21:340-3. [DOI: 10.1177/152692481102100414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intractable hiccups can be a serious complication in transplant recipients. Unfortunately, many of the pharmacotherapies used to stop hiccups are associated with severe side effects as well as drug-drug interactions with immunosuppressants. We report a case of a heart transplant recipient who had had intractable hiccups for 2 months, resulting in severe insomnia, diminished appetite, and weight loss. To treat the hiccups, treatment with oral baclofen (5–10 mg 3 times daily) was started. After 6 weeks of therapy, the baclofen was titrated down and discontinued because it had not stopped the hiccups and was causing severe central nervous system side effects. Gabapentin (100 mg twice daily) was then prescribed and within 24 hours of the start of that treatment, the hiccups had resolved completely. After 3 weeks of therapy, the patient had no side effects and the gabapentin was subsequently discontinued. One year after stopping the gabapentin, the patient remains free of hiccups. Gabapentin appears to be a promising medication for the treatment of intractable hiccups in thoracic transplant recipients because of its lack of serious side effects at low doses, rapid onset of action, and lack of drug-drug interactions with transplant medications.
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Affiliation(s)
- Robert L. Page
- University of Colorado (RLP, AB, JL), University of Colorado Hospital (ML), Aurora
| | - Megan Luna
- University of Colorado (RLP, AB, JL), University of Colorado Hospital (ML), Aurora
| | - Andreas Brieke
- University of Colorado (RLP, AB, JL), University of Colorado Hospital (ML), Aurora
| | - JoAnn Lindenfeld
- University of Colorado (RLP, AB, JL), University of Colorado Hospital (ML), Aurora
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Seker MM, Aksoy S, Ozdemir NY, Uncu D, Civelek B, Akıncı MB, Zengin N. Successful treatment of chronic hiccup with baclofen in cancer patients. Med Oncol 2011; 29:1369-70. [PMID: 21442315 DOI: 10.1007/s12032-011-9910-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 03/14/2011] [Indexed: 11/28/2022]
Abstract
Chronic hiccup is an infrequent but distressing symptom in patients with advanced cancer. A series of drugs (chlorpromazine, haloperidol, nifedipine, metoclopramide, baclofen) have been used to treat hiccup without definitive results. Some authors have suggested a possible role of baclofen in the treatment of chronic hiccup. We report three cases of chronic hiccup in patients with cancer successfully treated with baclofen.
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Affiliation(s)
- M Metin Seker
- Department of Medical Oncology, Ankara Numune Education and Research Hospital, 06100 Ankara, Turkey
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