Key Points
- Acid reflux is the common gastrointestinal cause of persistent hiccups
- Persistent hiccups last more than 48 hours
- Intractable hiccups linger for more than 2 months
- Other causes for persistent hiccups include certain medications and brain related conditions like stroke, multiple sclerosis and tumors
- At Houston heartburn and Reflux Center, hiatal hernia repair and Nissen fundoplication reliably eliminated hiccups in 8 GERD patients
What are Hiccups?
Hiccups happen when your breathing muscle (the diaphragm) suddenly and involuntarily contracts. This is immediately followed by vocal cords closure to prevent air from entering your lungs, resulting in the familiar “hic” sound associated with hiccups. Hiccups are typically transient. They are caused by minor irritations like drinking carbonated beverages, emotional stress or sudden change in temperature. Persistent hiccups last more than 48 hours, while intractable hiccups last more than 2 months. Both conditions are rare in the general population, as well as in the setting of acid reflux disease.
At Houston Heartburn and Reflux Center, hiccups are rarely reported by GERD patients. The incidence of hiccups in our GERD patient population is less than 1%. Most of these patients had severe erosive esophagitis. All patients with GERD reported complete hiccup resolution after successful hiatal hernia repair and Nissen fundoplication. Acid, bile and pepsin reflux results in inflammation around distal esophagus. It is thought that Inflammation stimulates vagus and phrenic nerve endings leading to activation of the hiccup reflex arc. The hiccup reflex arc is a series of sensory nerves that connect to motor nerves that control the breathing muscles and vocal cords. Stopping reflux, especially in the early phase of acid reflux disease, prior to irreversible changes to the hiccup reflex arc is likely to be associated with high success rate. The published literature on Nissen fundoplication success rate in eradicating persistent hiccups in the setting of GERD is limited. One case report showed persistent hiccups after Nissen fundoplication in a 67-year-old GERD patient despite acid reflux control. Interestingly, patient had also developed a stricture (narrowing of distal esophagus secondary to severe reflux). Stricture formation in the setting of GERD points to a severe and protracted reflux disease that might have irreversibly damaged the nerves involve in the hiccup reflux arc. Therefore, despite reflux control, hiccups persisted after anti-surgery in this patient.
If you suffer from persistent or intractable hiccups, contact your doctor for evaluation. If GERD is present, reflux control may help eliminate your hiccups.
References:
Hiccup: Mystery, Nature and Treatment.
Journal of Neurogastroenterology and Motility. 2012. Chang FY, Lu CL.
Hiccups: Esophageal Manometric Features and Relationship to GastroesophagealReflux.
The American Journal of Gastroenterology. 1990. Marshall JB, Landreneau RJ,
Beyer KL.
Hiccups and gastroesophageal reflux: cause and effect? Fisher MJ, Mittal
RK.Dig Dis Sci. 1989 Aug;34(8):1277-80.
Hiccups Associated With Reflux Esophagitis.
Gastroenterology. 1984. Shay SS, Myers RL, Johnson LF.