Singultus (Hiccups)

What is Singultus (Hiccups)?

Hiccups are something nearly everybody experiences at some time in their life. The medical term for hiccups is “singultus,” a word that comes from the Latin term “singult,” which means ‘to gasp while crying.’ Hiccups happen when the diaphragm and the muscles between the ribs contract unexpectedly and on their own. Right after these contractions, the opening between your vocal cords (the glottis) abruptly closes, causing the well-known “hic” sound.

Usually, hiccups don’t last long and go away within 48 hours. They can occur at any age – in adults, kids, babies, and even in unborn babies inside the womb. In adults, there isn’t any specific health benefit to hiccuping. However, it’s believed that they might play a role in training the breathing muscles in unborn babies.

Although brief bouts of hiccups might be slightly uncomfortable and a bit annoying, they usually don’t cause any serious issues. On the other hand, if hiccups persist and don’t stop, they could significantly affect quality of life. Persistent hiccups can disrupt eating, sleeping, speaking, and social activities. They could also be a warning sign of a serious health problem.

What Causes Singultus (Hiccups)?

Hiccups can be categorized based on how long they last. Acute hiccups last less than 48 hours, persistent hiccups last more than 2 days, and intractable hiccups last over a month. Most people do not report acute hiccups as they go away on their own, hence most research is on persistent and intractable hiccups. Hiccups can be caused by different factors such as physical conditions, psychological reasons, unknown causes, or as a result of medications. Persistent and intractable hiccups could indicate a more serious underlying condition.

Issues related to the stomach, especially gastroesophageal reflux disease (GERD), which is a chronic type of acid reflux, and associated hiatal hernias, which occur when part of your stomach pushes upward through your diaphragm, are the most common causes of acute hiccups. People suffering from GERD can have as much as a 10% chance of getting hiccups. Consuming large meals or carbonated drinks and eating spicy foods or drinking alcohol can make your stomach swell which often leads to hiccups. Also, up to a quarter of people with esophageal cancer, a type of cancer that starts in the food pipe, can have persistent hiccups. Excessive excitement or anxiety, especially when coupled with excessive breathing or swallowing air (like when you laugh a lot), can also trigger hiccups.

Several medications can cause hiccups, such as benzodiazepines, which are used to treat anxiety and other conditions. In low doses, these drugs can lead to hiccups but at higher doses, they might be used to treat hiccups. Some chemotherapy drugs and specific types of steroids are strongly associated with hiccups. Patients taking a combination of two drugs—cisplatin, a chemotherapy drug, and dexamethasone, a steroid—have almost a 42% chance of developing hiccups. Other drugs that can cause hiccups include various types of chemotherapy drugs, alpha-methyldopa, and inhaled anesthetics.

Persistent and intractable hiccups can be because of a variety of reasons, including:

Heart-related disorders: conditions like pacing of the upper chambers of the heart, bulging of a large blood vessel in the chest or abdomen, procedure to stop irregular heartbeats, heart attack, inflammation of the tissue that surrounds the heart, inflammation of the arteries.
Brain-related disorders: conditions like brain blood vessel bulges, brain inflammation, a group of neurological symptoms affecting the side of the brainstem, brain lining inflammation, multiple sclerosis, nerve and spinal cord inflammation, brain tumors including ones that start in star-shaped brain cells, Parkinson’s disease, seizures, stroke, spinal cord cavity, abnormal cluster of blood vessels in the brain.
Drugs such as alpha-methyldopa, aripiprazole, azithromycin, benzodiazepines (diazepam, midazolam), chemotherapy drugs (carboplatin, cisplatin, etoposide, fluorouracil, irinotecan, levofolinate, oxaliplatin), dexamethasone, donepezil, ethanol, levodopa, methohexital, morphine, pergolide, piribedil, sulfonamides, tramadol.
Respiratory-related disorders: conditions such as cough, foreign bodies irritating the eardrum (like hair), thyroid gland enlargement, laryngitis, neck cysts, tumors, throat inflammation, recent intubation.
Infectious diseases caused by bacteria, viruses, and parasites that affect the stomach and the nervous system.

Plus, several other causes, including abdominal- and lung-related conditions such as asthma, inflammation of the bronchial tubes, diaphragmatic tumors or hernias, pleuritis, pneumonia, and lung clots. Also, gastrointestinal conditions like air swallowing, bowel obstruction, stomach distention, esophageal cancer, gallbladder disease, hepatitis, pancreatic inflammation, peptic ulcer disease, twisted stomach, and subdiaphragm abscess. Furthermore, metabolic and hormonal disorders can cause hiccups too, as well as psychological causes like excitement, hyperventilation, intentional feigning of illness, stress-related hiccups. Lastly, surgical procedures and certain anesthetic agents can also cause hiccups.

Risk Factors and Frequency for Singultus (Hiccups)

Hiccups can happen to anyone, no matter their age. We don’t know exactly how common they are in the general population, and they don’t seem to be more frequent in any particular racial or geographic group. In the US, there are around 4,000 hospital admissions each year because of hiccups.

Chronic hiccups are mostly found in older, taller, and heavier males. People with certain health conditions may also have a higher chance of experiencing persistent hiccups. These conditions include:

Parkinson’s Disease
Advanced cancer, which increases the chance of hiccups by about 4-9%
Gastroesophageal reflux disease (GERD), raising the chance by about 8-10%

Signs and Symptoms of Singultus (Hiccups)

If you see a patient experiencing hiccups, you should take a detailed medical history. You should ask them if anything triggered their hiccups such as overeating, feeling excited, or experiencing emotional stress. You should also ask if they have any other symptoms such as reflux, coughing, weight loss, or stomach pain. Sometimes, hiccups may be linked to neurological issues such as stroke, multiple sclerosis, or Parkinson’s disease, so be sure to ask about any problems of this sort. Hiccups during sleep are rare, and if they occur, they may be due to gastric, neurological, or respiratory disorders. You should also ask about any recent surgeries, known cancers, and chemotherapy treatments the patient has had. Exploring their medication history may reveal a potential cause of the hiccups, if stopping a particular drug greatly reduces the episodes, then it’s likely that the medication was the cause.

For persistent or relentless hiccups, you should consider physical causes. A full head, eyes, ears, nose, and throat (HEENT) examination might show issues such as something like a hair or a foreign body touching against the eardrum, abnormal growths, enlarged thyroid, tonsillitis, and throat inflammation. Listening to the lungs might indicate chest-related causes such as pneumonia or a collection of pus in the cavities around the lungs. You should also examine the abdomen for sensitivity or any lumps that might suggest problems like blockage, twisted intestine, pancreatitis, hepatitis or an abnormal lump. A complete neurological examination may reveal issues related to the brain and spinal cord such as strokes and tumors, but it’s uncommon for hiccups to be the only sign.

Testing for Singultus (Hiccups)

Usually, a bout of hiccups is nothing to worry about and doesn’t need any medical attention. However, if your hiccups keep coming back or don’t go away, your doctor might want to check for underlying issues that could be causing them. They’ll typically start with examining your medical history and a physical exam.

Next, they might order some tests on your blood to check for issues such as imbalances in your electrolytes (minerals like potassium, sodium, and calcium that are needed for your body to function properly), ruling out infections or cancer. You might be also tested for blood urea nitrogen (a waste product in the blood), lipase (an enzyme that digests fats), and creatinine (a waste product made by your muscles). Liver tests can help check if your liver is working properly.

They might order a chest X-ray to see if you have something like pneumonia (an infection that inflames the lungs), empyema (pus in the space between the lung and the chest wall), diaphragmatic hernia (a birth defect where there’s a hole in the diaphragm), adenopathy (enlarged lymph nodes), or aortic disease (diseases affecting the main blood vessel supplying blood to the body).

If the hiccups are still a mystery, and you’re having symptoms related to your brain or nervous system, your doctor might order certain imaging tests for your brain. These tests, like a computerized tomography (CT) scan or a magnetic resonance imaging (MRI), can show if something like a stroke, a tumor, multiple sclerosis, or a hernia is to blame. In rare cases, they might take a sample of your spinal fluid to check for infections like meningitis or encephalitis which affect the brain and spinal cord.

In some other instances, they might scan your chest or abdomen to check for things like cancer, an aneurysm (a bulge in a blood vessel), abscess (a pocket of pus), or a hernia. If chronic or stubborn hiccups remain even after initial antacid and acid-blocking medication, your doctor might refer you to a specialist in diseases of the stomach and intestines to perform an upper endoscopy. This procedure enables the doctor to examine your esophagus to rule out problems such as esophageal cancer.

For example, if you’re on a ventilator and you develop hiccups, they might want to test your blood gases. Hiccups in someone on a ventilator may cause issues with syncing the breaths from the ventilator, severe changes in normal lung function, and changes in blood flow.

Treatment Options for Singultus (Hiccups)

In the early stages, simple physical maneuvers can often stop hiccups. Many of these tactics involve interfering with the hiccup reflex, which is the automatic response of your body to hiccup. For example, holding your breath, breathing into a paper bag, or trying to take in as much air as possible and hold it for a while can increase the amount of carbon dioxide in your blood, which can potentially decrease hiccups.

Among other strategies are stimulating the vagus nerve, which is a long nerve that runs from your brain to your stomach, through your nose, ear, and throat. Examples include drinking cold fluids, pulling on your tongue, exerting pressure on your neck and eyes, swallowing sugar, gargling, and even inducing vomiting. There have also reported cases of people stopping hiccups through sexual stimulation and rectal massage. Osteopaths or chiropractors can employ different manipulative techniques as well. However, these seem to work better for short-term hiccups.

Permanent or non-stop hiccups are more challenging to treat and usually require a more systematic approach. The first step is to check if the patient is consuming any medicine that might be causing the hiccups. These might be substituted for alternatives. Hiccups often accompany GERD (Gastroesophageal reflux disease), a digestive problem where acid from your stomach comes up into your esophagus. Therefore, a treatment plan could include antacids, antihistamines, or a class of drugs known as proton pump inhibitors to help manage acid reflux.

Pharmaceutical therapies are commonly used for non-stop cases. The goal is to target neurotransmitters, which are the communicators in the brain that help regulate body functions. Some substances involved in this process include dopamine, GABA, serotonin, acetylcholine, and a few others. Chlorpromazine was historically the drug of choice for non-stop hiccups and is currently the only one approved by the U.S. Food and Drug Administration. However, it may have side effects, leading to the use of other drugs, such as haloperidol and risperidone.

The most commonly researched medicines for persistent hiccups are metoclopramide, baclofen, and gabapentin. These drugs might have more manageable side effects. If a patient’s exam reveals no obvious cause for the hiccups, these drugs might be tried. Metoclopramide acts in the brain and gut. Baclofen reduces nerve excitation and relaxes muscles. Gabapentin, similar to GABA, also works to decrease nerve excitation.

Various other medications, like amantadine, antipsychotic agents, atropine, and others, have been suggested for treating non-stop hiccups based on individual experiences. During a surgery, doctors may use different medications to control hiccups. They might even use local anesthetics in different forms.

For hiccups resistant to medication, more invasive treatment options include acupuncture, positive pressure ventilation, stimulation of the vagus nerve, and blocking of the stellate or phrenic nerve. These strategies have limited trial support but might be beneficial in certain situations, such as intractable hiccups resulting from cancer or stroke. A procedure involving a breathing tube (intubation) might be successful in some hard-to-treat cases. If doctors consider cutting or blocking the phrenic nerve, a procedure to calm the hiccups, they must ensure that both sides of the diaphragm are functional before the procedure.

Diagnosing hiccups is typically straightforward, but they can sometimes be mistaken for symptoms like coughing or gagging. Several factors could trigger hiccups:

Certain medications
Anesthesia
Procedures like endoscopy
Sedation
Recovering from surgery (post-operative period)

Note that hiccups are often symptoms of other illnesses. The types of diseases that could bring about hiccups are numerous and wide-ranging. They could be from different sectors like:

Ear, nose and throat conditions
Central nervous system disorders
Cardiovascular problems
Gastrointestinal issues
Infections
Conditions within the chest (intrathoracic)
Metabolic disorders
Psychological (psychogenic) problems

What to expect with Singultus (Hiccups)

Hiccups are generally harmless and tend to go away on their own. Treating the root cause usually helps to lessen the frequency and duration of hiccups.

Possible Complications When Diagnosed with Singultus (Hiccups)

Acute hiccups, or short-term, sudden hiccups, can cause temporary discomfort. These hiccups can also result in acid reflux, emotional unrest, and in rare cases, the act of inhaling a foreign substance into the respiratory tract, also known as aspiration. However, persistent hiccups that are hard to control can significantly affect a person’s quality of life. The consequences may include difficulty in eating or drinking, which can then lead to dehydration, malnutrition, tiredness, weight loss, and disruption in sleep. Additional potential problems from long-lasting hiccups are feelings of hopelessness, depression, and extreme fatigue.

Persons who suffer from hiccups while being treated in Neuro ICU and are intubated or connected to a breathing machine might have complications. This can cause an inability to synchronize with the ventilator leading to changes in heart and blood circulation activities. In relation to surgeries, hiccups can interfere with the surgical process, post-surgery healing, particularly in areas around the chest and abdomen.

Forceful hiccups can also result in serious problems like slowing heart rate, damage to the carotid artery (a crucial artery supplying blood to the brain), lung damage from pressure (known as barotrauma), which in rare cases can cause a collapsed lung or air leakage into the space between the lungs and the chest wall, and a reduction of blood returning to the heart leading to low blood pressure.

Common Side Effects:

Temporary discomfort
Acid reflux
Emotional unrest
Aspiration (inhaling a foreign substance into the respiratory tract)
Dehydration
Malnutrition
Weight loss
Insomnia
Feelings of despair and depression
Extreme fatigue
Decreased venous return leading to low blood pressure
Possible heart or lung damage

Preventing Singultus (Hiccups)

Hiccups usually aren’t harmful and often go away on their own. If you’re experiencing short-term hiccups, it can be helpful to try certain physical exercises like holding your breath, and it’s important to know that the hiccups should pass soon. For healthy individuals without a clear reason for stubborn and ongoing hiccups, treating heartburn could help. Education about how to improve heartburn and digestion can be beneficial initial actions. Your doctor should guide you about potential disturbances to your everyday life that may occur as a result of the hiccups.

Frequently asked questions

The prognosis for hiccups (singultus) is generally good. They usually don't last long and go away within 48 hours. However, if hiccups persist and don't stop, they could significantly affect quality of life and may be a warning sign of a serious health problem. Treating the root cause usually helps to lessen the frequency and duration of hiccups.

Hiccups can be caused by various factors such as physical conditions, psychological reasons, unknown causes, or as a result of medications.

Signs and symptoms of Singultus (Hiccups) include: - Overeating - Feeling excited - Experiencing emotional stress - Reflux - Coughing - Weight loss - Stomach pain - Gastric, neurological, or respiratory disorders - Neurological issues such as stroke, multiple sclerosis, or Parkinson's disease - Rare occurrence during sleep - Recent surgeries - Known cancers - Chemotherapy treatments - Medication history (if stopping a particular drug greatly reduces the episodes, then it's likely that the medication was the cause) - Full head, eyes, ears, nose, and throat (HEENT) examination might show issues such as something like a hair or a foreign body touching against the eardrum, abnormal growths, enlarged thyroid, tonsillitis, and throat inflammation - Listening to the lungs might indicate chest-related causes such as pneumonia or a collection of pus in the cavities around the lungs - Abdominal examination for sensitivity or any lumps that might suggest problems like blockage, twisted intestine, pancreatitis, hepatitis, or an abnormal lump - Complete neurological examination may reveal issues related to the brain and spinal cord such as strokes and tumors, but it's uncommon for hiccups to be the only sign.

To properly diagnose Singultus (Hiccups), a doctor may order the following tests: 1. Blood tests: These tests can check for imbalances in electrolytes, rule out infections or cancer, and assess liver function. Specific blood tests may include checking blood urea nitrogen, lipase, and creatinine levels. 2. Chest X-ray: This imaging test can help identify conditions such as pneumonia, empyema, diaphragmatic hernia, adenopathy, or aortic disease that may be causing the hiccups. 3. Brain imaging tests: If there are symptoms related to the brain or nervous system, a doctor may order a CT scan or MRI to check for conditions like stroke, tumor, multiple sclerosis, or hernia. 4. Spinal fluid analysis: In rare cases, a doctor may take a sample of spinal fluid to check for infections like meningitis or encephalitis. 5. Upper endoscopy: If chronic hiccups persist even after initial treatment, a doctor may refer the patient to a specialist to perform an upper endoscopy to examine the esophagus and rule out problems like esophageal cancer. 6. Additional scans: Depending on the situation, a doctor may order chest or abdominal scans to check for conditions like cancer, aneurysm, abscess, or hernia. It's important to note that the specific tests ordered will depend on the individual patient's symptoms and medical history.

The doctor needs to rule out the following conditions when diagnosing Singultus (Hiccups): - Ear, nose and throat conditions - Central nervous system disorders - Cardiovascular problems - Gastrointestinal issues - Infections - Conditions within the chest (intrathoracic) - Metabolic disorders - Psychological (psychogenic) problems

The side effects when treating Singultus (Hiccups) can include temporary discomfort, acid reflux, emotional unrest, aspiration (inhaling a foreign substance into the respiratory tract), dehydration, malnutrition, weight loss, insomnia, feelings of despair and depression, extreme fatigue, decreased venous return leading to low blood pressure, and possible heart or lung damage.

You should see a doctor specializing in diseases of the stomach and intestines or a specialist in neurology.

We don't know exactly how common hiccups are in the general population.

Hiccups, also known as Singultus, can be treated through various methods depending on the severity and duration of the hiccups. In the early stages, simple physical maneuvers like holding your breath, breathing into a paper bag, or increasing carbon dioxide levels in the blood can help stop hiccups. Other strategies include stimulating the vagus nerve through techniques like drinking cold fluids, pulling on the tongue, or exerting pressure on the neck and eyes. Medications such as antacids, antihistamines, and proton pump inhibitors may be used to manage acid reflux, which can cause hiccups. Pharmaceutical therapies targeting neurotransmitters like dopamine and GABA can also be effective. If medications and non-invasive treatments fail, more invasive options like acupuncture, positive pressure ventilation, and nerve stimulation or blocking may be considered.

Singultus, also known as hiccups, is the medical term for the involuntary contractions of the diaphragm and muscles between the ribs that cause the well-known "hic" sound. It comes from the Latin term "singult," which means 'to gasp while crying.'

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