Persistent Hiccups: When to Seek ENT or Psychiatric Help?

Several days of continuous belching (not hiccups or fullness belching)?

Hello! Since last Monday, I have been experiencing persistent burping, which feels different from typical gastric burps and is not related to fullness.
I have seen two gastroenterologists, who prescribed medications for peptic ulcers and gastroesophageal reflux disease, but the continuous burping symptoms remain.
It feels like I can never stop burping, and whenever I open my mouth, I can burp several times in succession.
After each burp, there is a faint closing sound, and I feel a sensation of something stuck in my throat, as if there is a foreign body present.
This sensation is constant, and only briefly subsides for a few seconds after burping.
I have noticed that tilting my head back or lying down alleviates the burping symptoms.
Additionally, my gastrointestinal function seems normal; I do not experience pain, discomfort, or bloating, and my bowel movements are regular.
Therefore, I would like to ask if I should consider seeing an otolaryngologist or a psychiatrist, or if you have any other recommendations?

Xiao Chen, 20~29 year old female. Ask Date: 2021/06/19

Dr. Chen Shidian reply Gastroenterology and Hepatology

If gastrointestinal medications are ineffective, a consultation with a psychiatrist or further observation may be necessary.

Reply Date: 2021/06/19

More Info

Persistent hiccups, or chronic hiccups, can be a frustrating and uncomfortable condition. They can occur for various reasons, and when they persist for an extended period, it is essential to consider both physical and psychological factors. Based on your description, it seems you have already consulted a gastroenterologist, who prescribed medication for potential gastrointestinal issues, such as peptic ulcers or gastroesophageal reflux disease (GERD). However, since the hiccups persist despite treatment, it may be time to explore other avenues.

When to Seek Further Help
1. Ear, Nose, and Throat (ENT) Specialist: Since hiccups can sometimes be related to irritation or dysfunction in the diaphragm or the vagus nerve, which runs from the brain to the abdomen, consulting an ENT specialist could be beneficial. They can evaluate if there are any anatomical issues or irritations in the throat or esophagus that could be contributing to your symptoms.

2. Psychiatric Evaluation: Chronic hiccups can also have psychological components. Stress, anxiety, and other emotional factors can lead to or exacerbate hiccup episodes. If you find that your hiccups coincide with periods of heightened stress or anxiety, it might be worthwhile to consult a mental health professional. They can help determine if there is an underlying psychological issue that needs addressing, such as anxiety disorders or somatic symptom disorders.

3. Neurological Assessment: In some cases, persistent hiccups can be a sign of neurological issues. If the hiccups are accompanied by other symptoms, such as changes in sensation, weakness, or coordination, a consultation with a neurologist may be warranted.

Additional Considerations
- Lifestyle Modifications: Sometimes, lifestyle changes can help alleviate hiccups. Consider avoiding carbonated beverages, spicy foods, and eating too quickly. Staying hydrated and practicing relaxation techniques may also help.

- Home Remedies: Some people find relief from hiccups through various home remedies, such as holding your breath, drinking a glass of cold water quickly, or swallowing a teaspoon of sugar. While these methods may not work for everyone, they are worth trying.

- Monitoring Symptoms: Keep a diary of your symptoms, noting when the hiccups occur, their duration, and any associated factors (such as food intake, stress levels, or physical activity). This information can be valuable for healthcare providers in diagnosing the underlying cause.

Conclusion
In summary, since your hiccups have persisted despite treatment from a gastroenterologist, it may be beneficial to seek further evaluation from an ENT specialist or a mental health professional. Addressing both physical and psychological aspects can provide a more comprehensive approach to managing your symptoms. Remember that persistent hiccups can sometimes be a sign of an underlying condition, so it’s essential to continue seeking medical advice until you find a resolution. Your health and comfort are paramount, and there are various avenues to explore to help alleviate your symptoms.

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