Chronic Hiccups: Unraveling the Mystery of Persistent Gastrointestinal Issues

Persistent hiccups that cannot be cured?

Hello, I would like to inquire about a concern regarding my girlfriend.
It started about three years ago when she began experiencing increasing symptoms such as bloating, burping, dry heaving, vomiting, sudden vision changes, weakness in her limbs, numbness, dizziness, and headaches.
Initially, the burping seemed manageable and was thought to be just typical bloating.
However, as time went on, the intervals between her burps became shorter, and sometimes she would feel like the burps were stuck in her throat, leading to dry heaving and even vomiting.
There were instances where she would feel uncomfortable before bed or wake up during the night with the urge to burp or vomit.
She underwent an upper endoscopy, which revealed the presence of Helicobacter pylori.
The doctor suggested that this might be the cause, and after a prolonged course of antibiotics, she managed to eradicate the bacteria, but her symptoms persisted.
We conducted further tests, including blood work, which all returned normal results.
We also checked her pituitary gland and thyroid, but no issues were found.
After discussions with her doctor, it was suggested that she might be experiencing autonomic nervous system dysregulation.
She then consulted a psychiatrist, who confirmed the diagnosis.
Initially, medication helped improve her condition and her mood, but gradually it became less effective.
While other symptoms have disappeared, she still struggles with persistent burping, dry heaving, and vomiting.
The continuous burping sometimes leads to shortness of breath, elevated blood pressure, dizziness, headaches, and a racing heart.
We have tried eating smaller, more frequent meals, reducing cold foods, and consuming natural foods that are gentle on the stomach and fruits that aid digestion, but none of these have provided lasting relief—only temporary improvements for a day.
I would appreciate any advice on how we can further assist her.
Thank you.

ti nǚ yǒu dān xīn, 20~29 year old female. Ask Date: 2022/10/26

Dr. Lin Minghui reply Gastroenterology and Hepatology

Endless hiccups, dry heaving, and vomiting...
Additionally, due to continuous hiccups, there are difficulties in breathing, elevated blood pressure, dizziness, headaches, and increased heart rate.
A psychiatric evaluation has confirmed autonomic nervous system dysfunction.
Initially, medication provided some improvement, but symptoms persisted.
Dietary changes have been made, and there has been treatment for Helicobacter pylori eradication.
This situation appears to be somewhat complicated; a gastroenterologist may consider performing esophageal manometry.
It is recommended to address emotional issues.
Paying attention to diet and learning diaphragmatic breathing may be helpful.
Continued follow-up with both gastroenterology and psychiatry is advised.

Reply Date: 2022/10/26

More Info

Chronic hiccups and gastrointestinal issues can be quite distressing, as you've described in your girlfriend's case. The symptoms she is experiencing—bloating, persistent hiccups, dry heaving, vomiting, and episodes of dizziness and weakness—suggest a complex interplay of gastrointestinal and possibly neurological factors.
Firstly, it’s important to understand that hiccups are involuntary contractions of the diaphragm muscle, followed by a sudden closure of the vocal cords, which produces the characteristic "hic" sound. Chronic hiccups, defined as those lasting more than 48 hours, can be caused by a variety of factors, including gastrointestinal disorders, neurological conditions, and even psychological factors.

In your girlfriend's case, the initial diagnosis of Helicobacter pylori infection and subsequent treatment is significant. H. pylori is known to cause gastritis and peptic ulcers, which can lead to symptoms like bloating and nausea. However, even after successful eradication of the bacteria, some patients continue to experience gastrointestinal symptoms due to functional gastrointestinal disorders, such as Irritable Bowel Syndrome (IBS) or functional dyspepsia. These conditions can cause chronic bloating and discomfort, which might explain her ongoing symptoms.

The mention of autonomic nervous system dysregulation is also crucial. The autonomic nervous system controls involuntary bodily functions, including digestion. Stress and anxiety can exacerbate gastrointestinal symptoms and may lead to a cycle of discomfort and anxiety that perpetuates the symptoms. It’s not uncommon for patients with chronic gastrointestinal issues to experience anxiety or depression, which can further complicate their symptoms.

Given that your girlfriend has undergone extensive testing, including blood tests and imaging, and has ruled out significant organic diseases, the focus should shift towards managing her symptoms and improving her quality of life. Here are some recommendations that may help:
1. Dietary Modifications: Continue with a low-FODMAP diet, which has been shown to help many individuals with IBS. This diet reduces certain carbohydrates that can cause bloating and discomfort. Additionally, keeping a food diary may help identify specific triggers.

2. Behavioral Techniques: Encourage her to practice relaxation techniques such as deep breathing exercises, meditation, or yoga. These can help manage stress and may reduce the frequency of hiccups and gastrointestinal discomfort.

3. Medications: If she hasn’t already, it may be worth discussing with her healthcare provider the possibility of medications that can help with gastrointestinal motility or reduce anxiety. Prokinetic agents or medications like ondansetron may help with nausea and vomiting, while anxiolytics or antidepressants can assist with anxiety-related symptoms.

4. Physical Therapy: Some patients benefit from physical therapy focused on the abdominal area, which can help relieve tension and improve gastrointestinal function.

5. Follow-Up with Specialists: If her symptoms persist, consider consulting a gastroenterologist who specializes in functional gastrointestinal disorders. They may offer additional insights or treatment options, such as cognitive-behavioral therapy (CBT) for managing chronic symptoms.

6. Neurological Evaluation: Since she experiences dizziness and other neurological symptoms, a thorough evaluation by a neurologist may be warranted to rule out any underlying neurological conditions.

In conclusion, while the journey to find relief from chronic gastrointestinal symptoms can be challenging, a multidisciplinary approach that includes dietary changes, stress management, and possibly medication can significantly improve her quality of life. Encourage her to maintain open communication with her healthcare providers to tailor a treatment plan that best suits her needs.

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