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Runggaldier D, Adam R, Ermanni C, Colotto-Vith U, van Beek MEF, Posovszky C, Righini Grunder F, Pohl D, Bohlender JE. [Gastric vs. supragastric belching, singultus, aerophagia, and differential diagnoses : An interdisciplinary perspective for otorhinolaryngologists]. HNO 2024:10.1007/s00106-024-01495-y. [PMID: 38935275 DOI: 10.1007/s00106-024-01495-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 06/28/2024]
Abstract
Belching is the act of expelling air from the stomach or esophagus into the pharynx. Although the process is regarded as physiological, excessive belching might be associated with a significant burden for affected patients in the sense of a belching disorder. Diagnosis of a belching disorder is often challenging, and its differentiation from other conditions such as rumination syndrome, singultus, or aerophagia can be difficult. Treatment of these disorders also represents a challenge for otorhinolaryngologists. Hence, the aim of this review is to provide an interdisciplinary overview of these clinical syndromes and provide practical guidance for their diagnosis and treatment.
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Affiliation(s)
- Daniel Runggaldier
- Klinik für Otorhinolaryngologie, Head and Neck Surgery, Abt. Phoniatrie und Klinische Logopädie, Universitätsspital Zürich, Frauenklinikstrasse 24, 8091, Zürich, Schweiz.
- Universität Zürich, Zürich, Schweiz.
| | - Roman Adam
- Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich, Zürich, Schweiz
| | - Chiara Ermanni
- Klinik für Otorhinolaryngologie, Head and Neck Surgery, Abt. Phoniatrie und Klinische Logopädie, Universitätsspital Zürich, Frauenklinikstrasse 24, 8091, Zürich, Schweiz
- Universität Zürich, Zürich, Schweiz
- Klinik für Otorhinolaryngologie, Head and Neck Surgery, Universitätsspital Zürich, Frauenklinikstrasse 24, 8091, Zürich, Schweiz
| | - Ursula Colotto-Vith
- Klinik für Otorhinolaryngologie, Head and Neck Surgery, Abt. Phoniatrie und Klinische Logopädie, Universitätsspital Zürich, Frauenklinikstrasse 24, 8091, Zürich, Schweiz
- Universität Zürich, Zürich, Schweiz
| | - Miriam E F van Beek
- Klinik für Otorhinolaryngologie, Head and Neck Surgery, Abt. Phoniatrie und Klinische Logopädie, Universitätsspital Zürich, Frauenklinikstrasse 24, 8091, Zürich, Schweiz
- Universität Zürich, Zürich, Schweiz
| | - Carsten Posovszky
- Gastroenterologie, Hepatologie und Ernährung, Universitäts-Kinderspital Zürich, Zürich, Schweiz
| | - Franziska Righini Grunder
- Gastroenterologie, Hepatologie und Ernährung, Universitäts-Kinderspital Zürich, Zürich, Schweiz
- Gastroenterologie, Hepatologie und Ernährung, Kinderspital Zentralschweiz, Luzern, Schweiz
| | - Daniel Pohl
- Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich, Zürich, Schweiz
| | - Jörg E Bohlender
- Klinik für Otorhinolaryngologie, Head and Neck Surgery, Abt. Phoniatrie und Klinische Logopädie, Universitätsspital Zürich, Frauenklinikstrasse 24, 8091, Zürich, Schweiz
- Universität Zürich, Zürich, Schweiz
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Zaher A, Hans AK, Lukin DJ. An Unusual Hiccup: Severe Singultus as a Symptom in Ulcerative Colitis. ACG Case Rep J 2024; 11:e01258. [PMID: 38264174 PMCID: PMC10805412 DOI: 10.14309/crj.0000000000001258] [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: 10/08/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024] Open
Abstract
Inflammatory bowel disease encompasses a group of chronic inflammatory conditions associated with both intestinal and extraintestinal manifestations. We present a 26-year-old man with a history of ulcerative colitis who presented with a disease exacerbation associated with severe intractable hiccups. We report a unique clinical symptom associated with severe ulcerative colitis and the diagnostic dilemma associated with this presentation. This case highlights the importance of recognizing unusual symptoms that can be associated with inflammatory bowel disease exacerbations and demonstrates the therapeutic potential of effective therapy of the underlying inflammatory disease.
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Affiliation(s)
- Anas Zaher
- Department of Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - Amneet K. Hans
- Jill Roberts Center for Inflammatory Bowel Disease, Division of Gastroenterology and Hepatology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY
| | - Dana J. Lukin
- Jill Roberts Center for Inflammatory Bowel Disease, Division of Gastroenterology and Hepatology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY
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Recio SZ, Abdennadher M. Intractable hiccups after VNS implantation: a case report. BMC Neurol 2023; 23:297. [PMID: 37563736 PMCID: PMC10413770 DOI: 10.1186/s12883-023-03352-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Hiccups (medically termed, "singultus"), when intractable, can cause significant medical consequences such as aspiration, malnutrition, and depression, leading to poor quality of life. Several case reports have shown that vagus nerve stimulator (VNS) implantation can help treat central idiopathic intractable hiccups. However, we present a contrary case of a patient who developed intractable singultus following VNS placement for medically refractory epilepsy. CASE PRESENTATION We report a 71-year-old male patient with drug-resistant epilepsy who underwent VNS implantation and developed intractable hiccups shortly thereafter. The hiccups were severe and persistent, such that the patient developed a Mallory-Weiss tear, which required intensive care, invasive intubation and mechanical ventilation, and a prolonged rehabilitation course. Despite multiple therapies including phrenic nerve block and Nissen fundoplication, the patient's hiccups persisted and only stopped once the VNS was permanently deactivated. CONCLUSIONS Little is known about the incidence of hiccups after VNS implantation. We present one case of hiccups as a direct consequence of VNS implantation. The clinical impact of this report is significant given the relative unfamiliarity of hiccups as an adverse effect of VNS implantation. Neurologists and epileptologists, who present VNS implantation as a surgical option for seizure control to their patients, should be aware of the possibility of singultus development and its significant physical and emotional ramifications.
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Affiliation(s)
- Susan Zhang Recio
- Department of Neurology, Boston Medical Center/Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02118, USA
| | - Myriam Abdennadher
- Department of Neurology, Boston Medical Center/Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02118, USA.
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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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Esophageal Plasmacytoma Revealed by Persistent Hiccups: A Case Report and Literature Review. Case Rep Gastrointest Med 2022; 2022:2242768. [PMID: 35140989 PMCID: PMC8820904 DOI: 10.1155/2022/2242768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 01/17/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction. Solitary extramedullary plasmacytoma (SEP) is a rare neoplasm that is derived from monoclonal proliferation of plasma cells in the soft tissues or organs arising outside the bone marrow. It is present in about 3% of all plasma cell tumors and originates mainly from the upper respiratory tract and nasopharynx. Involvement of the esophagus is exceptionally seen in cases of SEP. Case Presentation. We report a novel case of a 74-year-old male patient attended with a 6-month history of hiccupping further associated with dysphasia and weight loss all caused by esophageal plasmacytoma. Histological and immunohistochemical examination of the tumor confirmed the diagnosis of plasmacytoma. Workup for the multiple myeloma came out to be negative, thus confirming the diagnosis of SEP. The patient was treated with radiotherapy alone, leading to complete remission (at 30 months of follow-up). Conclusion. Esophageal plasmacytoma, an exceptional presentation of extramedullary plasmacytoma, should be kept in mind while dealing with patients presenting with intractable hiccups.
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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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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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Zhang Y, Jiang X, Wang Z, He M, Lv Z, Yuan Q, Qin W. Efficacy of acupuncture for persistent and intractable hiccups: A protocol for systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e24879. [PMID: 33663115 PMCID: PMC7909209 DOI: 10.1097/md.0000000000024879] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Persistent and intractable hiccups are a common clinical symptom that cause considerable physical pain to patients and severely damage their quality of lives. An increasing number of studies have demonstrated that acupuncture applied at acupoints dominated by Cuanzhu (BL2) can be used as one of the nonpharmacological therapies for controlling intractable hiccups. However, there is insufficient evidence evaluating the safety and effectiveness of those interventions. Therefore, this study is intended to conduct a systematic review and meta-analysis to provide evidence for a further study investigating alternative treatment options for persistent and intractable hiccups. METHODS AND ANALYSIS Randomized controlled trials (RCTs) of adult patients aged >18 years who meet the criteria for intractable hiccup diagnosis will be included, regardless of gender, nationality, and education level. Eight electronic databases will be searched, including 4 Chinese databases (CNKI, SinoMed, Wanfang Database, and Chinese Scientific Journal Database), 4 English databases (Web of Science, Medline, Embase, and Cochrane Library), from their date of establishment to September 2020. Two independent reviewers will evaluate the title summary for each RCT. Disagreements will be discussed with a third commentator. Data integration, heterogeneity analysis, subgroup analysis, and sensitivity analysis, will be performed using R-3.3.2 software. The RevMan 5.3 software will be used for the meta-analysis, and the "risk of bias" assessment will be conducted based on the methodological quality of the included trials recommended by the Cochrane Handbook 5.1. The quality evaluation of this study will be completed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). RESULTS This study will summarize all the selected trials aimed at estimating the effectiveness, as well as safety, of applying acupuncture at acupoints dominated by Cuanzhu (BL2) to persistent and intractable hiccups. CONCLUSIONS This systematic review will provide evidence to assess the validity and safety of applying acupuncture at acupoints dominated by Cuanzhu (BL2) for persistent and intractable hiccups, which may provide clinicians with more choices in the treatment of this disease. PROSPERO REGISTRATION NUMBER CRD42020114900.
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Affiliation(s)
- Yu Zhang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei
| | - Xudong Jiang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei
| | - Zhijie Wang
- Shanxi Province Hospital of Traditional Chinese Medical, Taiyuan
| | - Mingming He
- The Fourth Department of Acupuncture and Moxibustion, Shaanxi Traditional Chinese Medicine Hospital, Xi’an
| | - Zimeng Lv
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei
| | - Qing Yuan
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weixun Qin
- The Fourth Department of Acupuncture and Moxibustion, Shaanxi Traditional Chinese Medicine Hospital, Xi’an
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Rajagopalan V, SenGupta D, Goyal K, Dube SK, Bindra A, Kedia S. Hiccups in neurocritical care. JOURNAL OF NEUROCRITICAL CARE 2021. [DOI: 10.18700/jnc.200018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Abstract
RATIONALE Hiccups are a common clinical symptom, and persistent hiccups and intractable hiccups severely impair the individual's quality of life. To date, there has been no effective treatment specifically for hiccups. Herein, we report 2 cases with intractable or persistent hiccups that were successfully treated with extracranial acupuncture. PATIENT CONCERNS The first case is a 46-year-old woman who presented with a 7-year history of intractable hiccups that had worsened over the past 3 years. She also complained of chest tightness, dyspnea, palpitations, dreaminess, dysphoria, intolerance of cold, and hypohidrosis. The second case is a 75-year-old man who presented with a 7-day history of persistent hiccups and hematemesis for 3 hours. The patient's persistent hiccups were treated using traditional Chinese acupuncture, but the patient reported no remarkable benefit. DIAGNOSES They were diagnosed as intractable or persistent hiccups. INTERVENTIONS They were treated with extracranial acupuncture. OUTCOMES The hiccups completely disappeared. During the follow-up period, the hiccups did not reappear. LESSONS According to neural balance theory, an episode of the hiccups is caused by an imbalance of the nervous system. Extracranial acupuncture in the area adjacent to the external occipital protuberance affects the intracranial nervous system, which can effectively control the hiccups. Our study provides a new approach to the treatment of hiccups.
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Affiliation(s)
- Zong-wang Zhang
- Department of Anesthesiology, Shandong Liaocheng People's Hospital, Liaocheng
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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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Li XB, Wu DJ, Yang MC. Acupuncture for hiccups: A systematic review protocol of high-quality randomized trials. Medicine (Baltimore) 2019; 98:e18343. [PMID: 31860989 PMCID: PMC6940168 DOI: 10.1097/md.0000000000018343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/13/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND A Hiccup is a common disease that often occurs along with other chronic or acute conditions. At present, there is a lack of feasible therapies for hiccups, and acupuncture is a treatment method with enormous clinical practice worldwide. METHODS Based on a pre-defined search strategy, we searched seven databases and screened them by two independent investigators, without language and publication status restriction from inception to date. We use the pre-set form to incorporate data and utilize Revman software to synthesize data. We will evaluate the risk of bias in the inclusion of the study based on the Cochrane 'Risk of bias' assessment tool. The quality of the evidence will be evaluated according to the GRADEpro software. RESULTS This systematic review will evaluate the efficacy and safety of acupuncture treatment for hiccups. The entire process will be referred to the Cochrane handbook recommended by the Cochrane Collaboration. CONCLUSION This review will provide systematic evidence to summarize whether acupuncture is an effective intervention in the treatment of hiccup.
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Affiliation(s)
- Xiao-Bing Li
- Department of Gastroenterology, The First People's Hospital of Pinghu City, Jiaxing
| | - Dong-Jie Wu
- Department of Chinese Medicine, Zhejiang Hospital, Hangzhou, China
| | - Min-Chun Yang
- Department of Chinese Medicine, Zhejiang Hospital, Hangzhou, China
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Gao H, Zhang B, Song L, Yao S, Zhang Z, Bai M. Acute proximal left anterior descending thrombosis manifested by persistent hiccups: A case report. Medicine (Baltimore) 2019; 98:e18096. [PMID: 31770229 PMCID: PMC6890347 DOI: 10.1097/md.0000000000018096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Hiccup is usually a benign and self-limited phenomenon. Therefore, if hiccups do not resolve by themselves and even last for a long time, it may be the marker of serious medical conditions. PATIENT CONCERNS We encountered a case presenting with recurrent abdominal discomfort. Diffuse ST-segment elevation in V2-V6 and elevated Troponin I was identified. He had complained about constipation and incomplete intestinal obstruction was ever suspected. Four days later, he exhibited persistent hiccups. DIAGNOSIS He was diagnosed with acute anterior wall myocardial infarction. And elective coronary angiography showed that proximal left anterior descending (LAD) was occluded by fresh thrombus with TIMI 1 flow. INTERVENTIONS The lesion in proximal LAD was dilated with low pressure. Interestingly, the hiccups reduced. And after stent implantation the hiccup disappeared in 24 hours. OUTCOMES The patient was discharged in good general condition, with maintenance therapy and a follow-up protocol. CONCLUSION Hiccup is only rarely described in the context of acute proximal LAD thrombosis. However, if this special symptom occurs intractably during disease progression, thrombus is revealed to be the probable cause, prompt opening of the criminal vessel should be performed besides strengthening of anticoagulant and antiplatelet.
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Abstract
PURPOSE OF REVIEW Hiccups are a common problem that crosses multiple disciplines including neurology, gastroenterology and pulmonology, and primary care. There are no formal guidelines to the treatment of intractable hiccups and treatment is based on experience and anecdotal evidence often relying on older medications. We have reviewed the relevant literature with an emphasis on the last five years or so in management of intractable hiccups. RECENT FINDINGS The production of hiccups is a complex mechanism which involves multiple neurotransmitters and anatomical structure within the central and peripheral nervous system. A number of medications and other therapy have been reported successful for intractable hiccups. Intractable hiccups can occur more often than we realize and present to multiple medical disciplines. A number of pharmacologic option have been found to be useful including dopamine-blocking medication, baclofen, and gabapentin along with anticonvulsants.
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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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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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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: 111] [Impact Index Per Article: 9.3] [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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Wilcox SK, Garry A, Johnson MJ. Novel use of amantadine: to treat hiccups. J Pain Symptom Manage 2009; 38:460-5. [PMID: 19735905 DOI: 10.1016/j.jpainsymman.2008.10.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Revised: 09/26/2008] [Accepted: 10/02/2008] [Indexed: 11/22/2022]
Abstract
Persistent hiccups may have a considerable impact on general health through disturbance of diet, sleep, and mood. They can cause exhaustion, malnutrition, dehydration, wound dehiscence, and even death in extreme cases. We report a complex clinical case of intractable hiccups in a patient with cancer of the pancreas and Parkinson's disease and some of the problems encountered when attempting symptom control. We also discuss a potential therapeutic response to a novel agent, amantadine, unlicensed in the treatment of hiccups.
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Affiliation(s)
- Sarah K Wilcox
- Palliative Care Team Office, Cancer Care Centre, York Hospital, York, UK.
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