HEALTH / Common Complaints: Hiccups

Dr Tony Smith
Saturday 05 September 1992 23:02

IT'S hiccup, rather than hiccough, though the origin of the word is as puzzling as the condition; the French say hocquet and the Spanish hipo, indicating an attempt to imitate the sound. The noise occurs when an involuntary intake of breath by contraction of the diaphragm is suddenly terminated by closing the glottis, the valve at the top of the windpipe. The victim of an attack of hiccups is more likely to be laughed at than given sympathy. Stage drunks hiccup, and many people treat the condition as if it were always due to some form of over-indulgence. In fact hiccups, especially if persistent during sleep, may be a symptom of serious disease and can be extremely difficult to treat.

The causes of trivial, short-lived attacks are said to include overeating and eating too fast, fizzy drinks, excesses of alcohol and tobacco, sudden excitement or emotional stress, and even a change in atmospheric temperature. The medical causes are more certain but the list is equally long. Hiccuping may occur after any general anaesthetic and after endoscopic examination of the throat and stomach. It may be a symptom of a disease of the diaphragm, such as an abscess or a tumour pressing on the muscle. Irritation of the nerves leading to the diaphragm from the brain could be the cause, particularly after a stroke. Or it may be due to liver or kidney disease upsetting internal chemistry.

The remedies for trivial hiccups are based mostly on distraction of the attention or irritation of the nose, in the hope of inducing a sneeze, which often seems to bring the attack to an end. They include drinking iced water or ordinary water from the wrong side of the glass, swallowing dry bread, pulling on the tongue, and inhaling ammonia or smelling salts. Other treatments are based on the principle that since the origin of hiccups is malfunctioning of the diaphragm, treatment must be concentrated on that target. Sufferers are urged to hold their breath, to breathe out against a closed glottis or into a paper bag, to pull up the knees to the chest or to bend down from the waist (so as to compress the diaphragm), or even to apply a mustard plaster to the lower chest. Some treatments involve stimulating the nerves leading to the stomach (somewhat illogical since these are not the same as those leading to the diaphragm) by pressure on the eyeballs, or massage of the carotid arteries in the neck. The stomach may be washed out or emptied by induced vomiting. Alternative and complementary remedies are sometimes recommended, ranging from acupuncture to hypnosis. One medical textbook even includes prayer in its list of suggestions.

Persistent hiccuping requires a more serious and systematic approach, with the prime target being identification and treatment of the cause. When the hiccup is a symptom of incurable disease, the first treatment will be with drugs. Mild sedation with a tranquilliser such as diazepam may be effective; or more powerful drugs, especially chlorpromazine and haloperidol, may be used. Metoclopramide suppresses vomiting and sometimes stops hiccups, too. If drugs don't work, the final resort is to block or cut one of the two phrenic nerves. This will paralyse half of the diaphragm. Even this drastic treatment is not always effective. Some unfortunate people hiccup for months and even years.

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