hiccups

Hiccups, also called singultus, are involuntary contractions of the diaphragm and sometimes the intercostal muscles. Each spasm is followed by a sudden closure of the glottis, which produces the characteristic sound commonly described as a “hic.”

Most hiccups are short-lived and benign, often triggered by minor factors such as eating or drinking too quickly, consuming carbonated beverages, swallowing air, sudden temperature changes, or emotional excitement. Less commonly, persistent or intractable hiccups may be linked to underlying medical conditions or medications. Possible associations include gastrointestinal distension or reflux, central nervous system disorders, metabolic imbalances (such as kidney failure or electrolyte abnormalities), anesthesia or surgery, and certain drugs (for example corticosteroids or benzodiazepines).

Classification varies, but a common scheme defines acute hiccups as lasting less than 48 hours. If hiccups persist beyond 48 hours, they are termed persistent; when they continue for more than about a month, they are considered intractable.

Diagnosis is usually clinical, focusing on history and physical exam. Persistent or intractable cases prompt evaluation for underlying causes, which may include laboratory tests, imaging, endoscopy, or neurological assessment as indicated.

Treatment is not always necessary, and many episodes resolve on their own. Home remedies aim to interrupt the reflex arc (for example, slow or deliberate breathing, breath-holding, sipping water, swallowing sugar, or gentle gagging), though evidence is mixed. For persistent or intractable hiccups, pharmacologic therapy may be used, with chlorpromazine commonly employed. Alternatives include baclofen, metoclopramide, and gabapentin. In rare or refractory cases, procedures such as nerve stimulation or, less often, nerve blocks may be attempted. The prognosis is generally favorable when an underlying cause is identified and managed.