Persistent Hiccups: Causes and Solutions for Relief

Hello, doctor. I would like to inquire about the issue of persistent hiccups?

Hello, doctor.
Back in mid-December 2018, after eating too much, I started experiencing an inexplicable urge to burp, as if there was gas trapped in my throat.
I have to forcefully push to release a burp, and sometimes I even feel like I'm burping up stomach acid when I push too hard.
This symptom occurs sometimes after eating too much, sometimes when I'm too hungry, and occasionally during normal times as well.
I also notice that I always burp a little after drinking water, but I can't recall when this started.
Additionally, I feel a sensation of acidic burping when I exercise three hours after a meal, even though I feel like I've waited long enough before exercising, it still feels uncomfortable.
I underwent an endoscopy, abdominal ultrasound, and blood tests in early January 2019, and the doctor said I had mild gastroesophageal reflux and gastritis, indicating that there wasn't a major issue.
However, two years ago, when I had an endoscopy and colonoscopy, I was diagnosed with gastroesophageal reflux and irritable bowel syndrome, but I didn't experience such discomfort back then.
I'm wondering if my condition has worsened, or if it's due to stress or lack of sleep.
I'm not sure if there are any ways to improve this issue with burping and acidic reflux, as the medications prescribed for gastritis and gastroesophageal reflux haven't significantly helped.
I apologize for troubling you, but this issue is really distressing for me.

WW, 20~29 year old female. Ask Date: 2019/01/24

Dr. Chen Qifeng reply Gastroenterology and Hepatology

In addition to medication, it is recommended to reduce tea and coffee intake, avoid stimulating foods and glutinous rice products, refrain from consuming overly sweet or sour foods, limit tea and soda consumption, and eat until about 80% full.

Reply Date: 2019/01/24

More Info

Persistent hiccups can be a frustrating and uncomfortable condition, often leading to concerns about underlying health issues. Based on your description, it seems that you have been experiencing these symptoms for quite some time, particularly after eating or drinking, and even during physical activity. You have already undergone several diagnostic tests, including an endoscopy and abdominal ultrasound, which revealed mild gastroesophageal reflux disease (GERD) and gastritis. While these findings are significant, they may not fully explain your persistent hiccups.

Hiccups occur when the diaphragm, the muscle that separates the chest from the abdomen and plays a crucial role in breathing, involuntarily contracts. This contraction is followed by a sudden closure of the vocal cords, which produces the characteristic "hic" sound. There are various potential causes for persistent hiccups, including:
1. Gastroesophageal Reflux Disease (GERD): As you mentioned, GERD can lead to irritation of the diaphragm and esophagus, potentially triggering hiccups. The acid reflux can cause discomfort and may lead to the sensation of needing to hiccup.

2. Overeating or Eating Too Quickly: Consuming large meals or eating too fast can cause the stomach to expand rapidly, which may irritate the diaphragm and lead to hiccups. It’s essential to eat smaller, more frequent meals and chew food thoroughly.

3. Carbonated Beverages: Drinking carbonated drinks can introduce excess air into the stomach, leading to bloating and hiccups. If you notice that certain beverages trigger your symptoms, it may be helpful to limit or avoid them.

4. Stress and Anxiety: Emotional factors can also play a role in the onset of hiccups. Stress and anxiety can lead to muscle tension, including in the diaphragm, which may contribute to the hiccup reflex.

5. Physical Activity: Engaging in physical activity shortly after eating can exacerbate symptoms of GERD and may lead to hiccups. It’s advisable to wait at least two to three hours after a meal before exercising.

6. Underlying Medical Conditions: While less common, persistent hiccups can sometimes be associated with neurological conditions, metabolic disorders, or even certain medications. If your symptoms persist despite treatment, further evaluation may be warranted.

To manage and alleviate your symptoms, consider the following strategies:
- Dietary Modifications: Focus on smaller, more frequent meals. Avoid spicy, fatty, or acidic foods that may exacerbate GERD. Keeping a food diary can help identify specific triggers.

- Hydration: Drink water slowly and avoid gulping, which can introduce air into the stomach. Sipping warm water may also help soothe the diaphragm.

- Relaxation Techniques: Incorporate stress-reducing practices such as deep breathing exercises, meditation, or yoga. These can help alleviate tension and may reduce the frequency of hiccups.

- Posture: Maintain an upright posture while eating and for a period afterward to minimize reflux. Avoid lying down immediately after meals.

- Medical Review: If your symptoms persist or worsen, it may be beneficial to revisit your healthcare provider. They may consider adjusting your medication or exploring additional treatment options, such as proton pump inhibitors or other medications that target GERD.

In conclusion, while persistent hiccups can be bothersome, understanding their potential causes and implementing lifestyle changes can often lead to relief. If symptoms continue to disrupt your daily life, seeking further medical advice is crucial to ensure that any underlying conditions are adequately addressed.

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