Chronic hiccups or long-lasting hiccups refers to involuntary, sudden spasms of the diaphragm (the muscle that separates the abdominal and chest cavities), followed by rapid closure of the vocal cords and the production of a “hiccup” sound at the top of the windpipe.

Hiccups usually last for a short period of time, generally minutes or hours, but chronic hiccups persist for extended periods (more than two days) and sometimes for longer than a month.

Prognosis

The prognosis for people with chronic hiccups depends on the underlying cause of the problem, which can vary in severity. Regardless of the cause, but depending on how long the hiccups last, the condition can eventually disrupt sleeping and eating patterns, leading to complications such as exhaustion, dehydration, and weight loss.

Cause

The underlying cause of chronic hiccups often cannot be determined, but cases may be caused by various health conditions such as those that affect the central nervous system or irritate the diaphragm, psychological problems, and metabolic diseases. Other causes include surgery and the use of certain medications.

• If the underlying cause of chronic hiccups can be determined, treatments can be used to target and relieve the problem. The tests a doctor may carry out in order to establish the cause include physical examination, laboratory tests, imaging tests, and endoscopic tests.
• Physical examination – Neurological tests may be carried out in order to help check balance, coordination, muscle strength, muscle tone, sight, sense of touch, and reflexes.
• Laboratory tests – These may include blood tests to check for infection or metabolic diseases such as diabetes or kidney conditions.
• Imaging tests – These may be performed to look for any abnormalities that may be affecting the diaphragm or the nerves that serve the diaphragm, specifically the vagus nerve and phrenic nerve. Examples include computerized tomography, magnetic resonance imaging, and X-ray.
• Endoscopy tests – Here, a small, bendy tube with a camera attached at one end is passed down the throat to check that the esophagus and windpipe are healthy.

Treatment

In cases where an underlying cause can be established, treating the problem can resolve the hiccups. For example, if a person is found to have gastro-esophageal reflux disease, a drug called a proton pump inhibitor may be prescribed, which reduces the level of acid present in the stomach. Medical conditions thought to be causing the hiccups may require evaluation by a specialist, in which case the patient is referred by their doctor so that further tests can be performed and the appropriate treatment recommended.

In cases of chronic hiccups that fail to respond to treatment and where no cause can be determined, a patient may be prescribed medications specifically designed to alleviate hiccups.

One of these medications is usually prescribed for a period of several weeks, with the dose gradually being increased, if necessary, to bring the problem under control. Following this, the dose is then gradually reduced until it is no longer necessary to take the drug. If the hiccups return once the dose is reduced or after the medication is stopped, a patient may be prescribed an increased dose again or advised to start the treatment again. If the initial drug prescribed still fails to resolve the problem, an alternative medication may be suggested. All of the drugs used to treat hiccups can cause side effects and individuals must ensure they discuss these with their doctor before initiating treatment.

If a patient fails to respond to medication for their hiccups, injection of an anesthetic that blocks the phrenic nerve may be recommended. Another procedure that may be advised is the surgical implantation of a device that electrically stimulates the vagus nerve.