Hiccups: The Connection Between Autonomic Nervous System and Gastrointestinal Issues

Autonomic nervous system dysfunction, diaphragmatic issues?

At the end of January this year, I experienced bloating and persistent burping, feeling as if gas was stuck in my throat.
Every time I attempted to swallow, I would burp every 3-5 seconds, which was a constant occurrence throughout the day except when I was sleeping.
I consulted a gastroenterologist and explained my symptoms.
The doctor suspected an issue with the autonomic nervous system (I found information linking this to burping, and I also have anxiety and insomnia, for which I take sleeping pills).
The doctor prescribed medication (including a medication for the autonomic nervous system), and my bloating quickly subsided, with burping becoming less frequent and more spaced out.
After a month of follow-up and medication, I still hadn't recovered, so I was scheduled for an endoscopy, which revealed Grade A gastroesophageal reflux disease (GERD) without the typical symptoms of sour taste in the throat or heartburn.
After adjusting the treatment plan and taking the new medication for two months, I still did not improve, especially after dinner and bowel movements.
I was then referred to a neurology department at a large hospital.
There, I explained my situation and underwent autonomic nervous system tests, MRI scans, and several blood tests, all of which came back normal (the neurologist only prescribed sleeping pills).
The conclusion from the neurology department was still that it was an autonomic nervous system issue, so I was referred back to the gastroenterology department.
However, I did not return for further medication as the doctor had advised me not to continue taking the medication for too long.
I reduced my intake, and it has been over six months since I stopped the medication.
Occasionally, I still burp, but it is manageable, so I have not returned for follow-up.
Although the symptoms have lessened, they have not completely resolved.
Recently, due to interpersonal and work-related anxiety, the symptoms worsened again, prompting me to return for a follow-up.
However, the doctor had left, and I switched to another gastroenterologist.
The new doctor believes it is caused by gastroesophageal reflux, but I personally feel it is a combination of psychogenic factors and GERD.
The doctor noted that I do not burp while talking to him, and I have also noticed that focusing on a task seems to distract me.
However, as soon as I think about burping, I can do it immediately.
Should I see a psychiatrist or return to the neurology department? Why did the neurology department conclude it was an autonomic nervous system issue despite normal test results from the autonomic nervous system evaluation, endoscopy (no tumors or polyps), and MRI? I am still burping frequently.
What exactly is the problem? Thank you.

77, 20~29 year old female. Ask Date: 2022/06/29

Dr. Chen Shidian reply Gastroenterology and Hepatology

Please continue the discussion with a gastroenterologist/psychiatrist.

Reply Date: 2022/06/29

More Info

Hiccups can be a perplexing symptom, often linked to various underlying conditions, including issues related to the autonomic nervous system (ANS) and gastrointestinal (GI) disturbances. Your situation, characterized by persistent hiccups, bloating, and anxiety, suggests a complex interplay between these systems.

The autonomic nervous system regulates involuntary bodily functions, including digestion and respiratory patterns. When the ANS is disrupted, it can lead to gastrointestinal symptoms such as bloating, discomfort, and hiccups. Stress and anxiety are known to exacerbate these symptoms, as they can trigger the "fight or flight" response, which may alter digestive processes and lead to increased air swallowing or changes in esophageal function, resulting in hiccups.

Your experience of frequent hiccups, particularly after meals or during periods of heightened anxiety, aligns with this understanding. The fact that your hiccups seem to diminish when you are focused on other tasks indicates a potential psychological component, where anxiety may be a significant trigger. This phenomenon is not uncommon; stress can manifest physically in various ways, including gastrointestinal disturbances.

The diagnosis of gastroesophageal reflux disease (GERD) you received from your gastroenterologist is also relevant. GERD can cause symptoms such as heartburn and regurgitation, but it can also lead to hiccups due to irritation of the esophagus and diaphragm. The connection between GERD and the ANS is significant, as the vagus nerve, part of the ANS, plays a crucial role in regulating the digestive tract and can be affected by reflux.

Your treatment journey has included medications for anxiety and digestive issues, which is a common approach. However, the persistence of your symptoms despite treatment suggests that a multifaceted approach may be necessary. It’s essential to consider both the physiological and psychological aspects of your condition.
Given that your autonomic nervous system tests and imaging studies (like MRI) have returned normal results, it may be beneficial to explore psychological interventions, such as cognitive-behavioral therapy (CBT) or mindfulness techniques, which can help manage anxiety and its physical manifestations. These therapies can assist in breaking the cycle of anxiety and physical symptoms, potentially reducing the frequency of hiccups and other GI discomforts.

Additionally, consulting with a specialist in psychosomatic medicine or a psychiatrist who understands the interplay between mental health and physical symptoms may provide further insights and treatment options. They can help you address the anxiety component more directly, which seems to be a significant factor in your symptoms.

In summary, your persistent hiccups and gastrointestinal discomfort likely stem from a combination of autonomic nervous system dysregulation, gastrointestinal issues like GERD, and psychological factors such as anxiety. A comprehensive treatment plan that addresses both the physical and psychological aspects of your condition may be the most effective approach. Regular follow-ups with your healthcare providers, along with exploring psychological support, can help you manage your symptoms more effectively and improve your overall quality of life.

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