Article Text

PDF
Management of hiccups in palliative care patients
  1. Yong Suk Jeon1,
  2. Alison Mary Kearney1,2 and
  3. Peter Graham Baker3
  1. 1School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
  2. 2Department of Palliative and Supportive Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  3. 3Discipline of General Practice, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
  1. Correspondence to Dr Alison Mary Kearney, Department of Palliative and Supportive Care, Royal Brisbane and Women's Hospital, School of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia; Alison.Kearney{at}health.qld.gov.au

Abstract

Persistent hiccups are a frustrating experience for palliative care patients, and can have a profound impact on their quality of life. This article provides an evidence-based approach overview of the causes and treatment of this not infrequently debilitating condition for such patients, with a management algorithm. In situations where no readily reversible cause is identified, or where simple physical manoeuvres, such as breath holding have failed, a systematic approach is required. Hiccups can be broadly divided into central and peripheral types. These respond differently to pharmacological intervention. The drug of choice for central causes of persistent hiccups is baclofen, with metoclopramide recommended as the first choice for peripheral causes. Midazolam may be useful in cases of terminal illness. Interventional procedures such as vagal or phrenic nerve block or stimulation should be considered in patients who are refractory to medications. The management of persistent hiccups still presents an ongoing clinical challenge however, requiring further research on pathophysiology and treatment strategies. Multinational randomised controlled trials to evaluate and compare both current and new medications or procedures to better manage this difficult condition are suggested as a means of reaching this goal.

  • palliative care
  • hiccup
  • persistent
  • intractable
  • management
  • terminal care
  • hospice

Statistics from Altmetric.com

Footnotes

  • Contributors Conception or design of the work: AMK. Data collection: YSJ. Data analysis and interpretation: YSJ. Drafting the article: YSJ. Critical revision of the article: AMK, PGB. Final approval of the version to be published: YSJ, AMK, PGB.

  • Competing interests None declared.

  • Ethics approval This article does not contain any studies with human or animal subjects performed by any of the authors. No study approval was obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.