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Chronic hiccup is a rare movement disorder characterized by involuntary spasmodic contractions of the inspiratory muscles synchronized with larynx closure lasting for more than 48 hours.
ORPHA:396Classification level: Disorder
- Synonym(s): -
- Prevalence: 1-9 / 100 000
- Inheritance: Not applicable
- Age of onset: All ages
- ICD-10: -
- OMIM: -
- UMLS: -
- MeSH: -
- GARD: 6657
- MedDRA: -
The disorder is thought to affect approximately 1/100,000 individuals. Chronic hiccup affect males more often than females.
The involuntary spasmodic contractions of the inspiratory muscles followed by the rapid closure of the vocal cords known as hiccups usually last for no more than a few minutes or at most a few hours with spontaneous resolution, and can affect people of any age. In rare pathological cases, hiccups may last for more than two days (chronic /persistent hiccup). Recurrent episodes over long periods are also called chronic hiccup. Clinical repercussions of these episodes may include dehydration, weight loss and malnutrition due to difficulty eating, sleep disorders, depression and exhaustion.
The hiccup is poorly understood. According to experimental data it is probably a coordinated ventilatory movement mixing branchial ventilation, suction and deglutition components. Chronic hiccup is mainly an esophageal and gastric disorder. Other causes may include fever, brain lesions/tumors, cardiovascular disorders (stroke, myocardial infarction), renal failure, metabolic imbalance, peripheral nerve stimulation, or other injuries, drugs (chemotherapy, benzodiazepines, corticosteroids, barbiturates, morphine, and anesthetics), and alcohol. Other triggers include placement of medical instruments, certain foods and beverages, spices and tobacco. Cases also sometimes develop in a context of surgery (pleural, peritoneal or intracranial).
Clinical diagnosis is usually straightforward given the nature of the involuntary spasms. Imaging or laboratory tests to identify the underlying cause should focus primarily on the esophagus.
Hiccups are extremely specific and can rarely be mistaken for another condition.
Management and treatment
Many anecdotal treatments have been described with varying success. Management should ideally focus on identifying and treating the underlying cause, especially esophageal. No specific treatments have proven efficacy in the absence of controlled studies. Pharmacological approaches that have been attempted in cases where no gastroesophageal treatment works include baclofen, chlorpromazine, carbamazepine, haloperidol, metoclopramide, gabapentin, serotoninergic agonists, prokinetics, lidocaine, nifedipine, carvedilol and marijuana. Alternative therapy includes hypnosis and acupuncture. Phrenic nerve blockade is of little benefit since it yields only partial relief at the expense of respiratory insufficiency. Long-term treatment of the frequent esophageal cause can be very useful.
Persistent hiccups can reduce quality of life. Very long intractable disease may be debilitating.
- Review article
- English (2012)