Chronic Hiccups: Causes, Symptoms, and Treatment Options

Chronic hiccups?

My father has been experiencing hiccups, which led him to quit drinking alcohol.
He tends to get hiccups whenever he eats more than one bowl of rice, and once they start, they can persist without stopping.
This seems to occur in cycles, lasting about one to two weeks each time, and even disrupts his sleep.
As a result, his appetite has decreased, leading to weight loss.
He has sought medical attention from various doctors, including gastroenterologists and traditional Chinese medicine practitioners, and has undergone endoscopy without any abnormalities found.
We have also considered psychological factors, but medications have not been effective.
We are very concerned as we see my father losing weight.
Dr.
Wu, are we looking in the wrong direction for his diagnosis?

sunny, 40~49 year old female. Ask Date: 2024/01/27

Dr. Hu Guozheng reply Gastroenterology and Hepatology

If liver, gallbladder, and gastrointestinal issues have been ruled out, please refer the elder to a neurology outpatient clinic for evaluation.
Thank you.

Reply Date: 2024/01/27

More Info

Chronic hiccups, defined as persistent hiccups lasting more than 48 hours, can be a frustrating and distressing condition, particularly when they interfere with daily activities and quality of life. Your father's experience of having hiccups triggered by eating, along with their cyclical nature, is concerning, especially given the impact on his appetite and overall health.

Causes of Chronic Hiccups
Chronic hiccups can arise from a variety of causes, which can be broadly categorized into physiological, neurological, and psychological factors:
1. Physiological Causes: These include irritations or disturbances in the diaphragm, which is the muscle responsible for breathing. Conditions such as gastroesophageal reflux disease (GERD), where stomach acid irritates the esophagus, can lead to hiccups. Additionally, overeating or consuming carbonated beverages can also trigger hiccups.

2. Neurological Causes: Hiccups can be linked to issues affecting the central nervous system, including strokes, multiple sclerosis, or brain injuries. These conditions can disrupt the neural pathways that control the hiccup reflex.

3. Psychological Factors: Stress and anxiety can also contribute to hiccups. While you mentioned that psychological factors were considered, it’s essential to explore this avenue further, as stress can exacerbate physical symptoms.

4. Medications: Certain medications, particularly those affecting the central nervous system, can lead to hiccups as a side effect. If your father is on any medications, it may be worth reviewing them with his healthcare provider.

Symptoms
The primary symptom of hiccups is the involuntary contraction of the diaphragm, followed by a sudden closure of the vocal cords, which produces the characteristic "hic" sound. In chronic cases, hiccups can lead to:
- Disrupted sleep, as you noted, which can further exacerbate fatigue and weight loss.

- Reduced appetite due to the fear of triggering hiccups after eating.

- Emotional distress, as the persistent nature of the condition can lead to anxiety or depression.

Treatment Options
Given that your father has already seen specialists without finding a definitive cause, it may be time to consider a multidisciplinary approach:
1. Dietary Modifications: Encourage smaller, more frequent meals rather than large ones, and avoid known triggers such as spicy foods, carbonated drinks, and alcohol. Keeping a food diary may help identify specific triggers.

2. Medications: There are several medications that have been used to treat chronic hiccups, including baclofen, gabapentin, and metoclopramide. These should be discussed with a healthcare provider who can evaluate their appropriateness based on your father's overall health and any other medications he may be taking.

3. Behavioral Techniques: Some patients find relief through behavioral techniques such as diaphragmatic breathing exercises, which can help relax the diaphragm and reduce hiccup frequency.

4. Psychological Support: If stress or anxiety is a contributing factor, consulting with a mental health professional may be beneficial. Cognitive-behavioral therapy (CBT) can help manage anxiety and its physical manifestations.

5. Further Investigations: If hiccups persist, it may be worthwhile to consider further investigations, such as imaging studies or consultations with a neurologist, to rule out any underlying neurological conditions.

Conclusion
It is understandable that you and your family are concerned about your father's health, especially with the weight loss and decreased appetite. Chronic hiccups can be complex and may require a comprehensive approach to management. It may be beneficial to revisit the healthcare provider with a detailed account of your father's symptoms, dietary habits, and any treatments tried thus far. This can help guide further investigations or adjustments in treatment strategies. Your father's well-being is paramount, and finding the right combination of treatments may take time and persistence.

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