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Q: I suffer from what I call "compound hiccups" for lack of a better term. I get normal hiccups quite frequently and occasionally I'll get between 3 and 10 rapidly in a row, like a diaphragm spasm or something. They are very painful and I was wondering if this was something that you have heard of. Any information is appreciated.
A: The diaphragm is a sheet of muscle and tendon separating the chest from the abdomen. When breathing in, it moves downwards, and when letting the air out, it moves back up. Hiccups, also referred to as singultus, is caused by a spasm of the diaphragm
followed by sudden closure of the glottis when breathing in. When the glottis closes, a feeling of discomfort and pain arises during this process because the diaphragm is still contracting and a marked decrease in pressure within the chest cavity occurs. Hiccups are usually benign and do not have any particular consequences except for the feeling of discomfort associated with them. However, there are generally many possible causes of hiccups and, when they are persistent or frequently recur, they may be a sign of a serious illness. In general, possible causes of hiccups include central nervous system disorders, metabolic causes, irritation of the diaphragmatic nerve ( i.e., the phrenic nerve), irritation of the diaphragm itself, irritation of the lining of the diaphragm on the chest side (the diaphragmatic pleura), or irritation of the lining of the diaphragm on the abdominal side (the peritoneal membrane). Typical central nervous system causes are infections, trauma, stroke, and tumors. Typical metabolic causes include severe kidney failure, electrolyte imbalance, and hyperventilation. Irritation of the prenic nerve, diaphragm, pleura, or peritoneal membrane, respectively, may be due to tumors, goiter (an enlaged thyroid gland), foreign bodies, inflammation of the esophagus, obstruction within the esophagus, enlarged liver, hepatitis, distention of the stomach, stomach tumors, inflammation of the pancreas, pancreatic tumors, inflammation of the gallbladder, anesthesia, following surgery, psychogenic reasons, etc. This list is by no means exhaustive. However, it clearly shows that there are many possible reasons for this condition.
When a patient with persistent hiccups comes to the physician, he/she should do a careful history and physical examination, as well as a blood test to evaluate blood electrolytes, kidney function, and liver function. In addition, a chest radiograph should also be performed to evaluate the chest cavity. When no obvious cause for the hiccups is found even after performing these tests, further testing might be needed. These tests include a CT scan or MRI of the head, chest, and abdomen, an ultrasound of the abdomen, an echocardiogram, an upper endoscopy (to evaluate the esophagus and stomach), or a bronchoscopy to evaluate the bronchial tree.
Tratment of this condition consists in relieving their actual cause, if it has been determined. In case there is no pathologic reason for the hiccups, treatment may consist in using chlorpromazine at the lowest effective dose, usually in the form of 10 to 25 milligrams tablets four to six times a day. In addition, there are also other agents that have been reported as being of benefit in relieving symptoms. These include: metoclopramide, baclofen, phenytoin, and carbamazepine.
In your case, I would suggest that you see your physician so that he/she evaluates you along the lines illustrated above. Once your
physician is certain that there is no pathology which is responsible for your hiccups, it might also be worthwhile to institute therapy with one of the agents mentioned above for symptomatic relief. However, the best way to proceed in your case should be decided by your physician after he/she has carefully evaluated you.
Updated: 06/20/99
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