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Why palliate hiccups?
First, hiccups are troubling. In our qualitative research, patients explain how hiccups make their beds shake at night, keeping them sleepless and exhausted. They describe how chronic hiccups detract from interpersonal relationships, making it difficult to even hold down a job. The literature describes fatigue, panic, difficulty eating, aspiration, pain and, at times, death.1 For healthcare providers, an unwillingness to acknowledge and try to palliate severe hiccups is not an option. Second, an article on hiccup pathophysiology concludes, ‘So hiccups could be good for nothing’.2 An elaborate circuitry, which recruits the medulla oblongata, reticular formation, hypothalamus and upper spinal cord as well as the vagus, phrenic and sympathetic nerves, triggers the contraction of the diaphragm and other thoracic musculature, which together propel air into the glottis, resulting in the pathognomonic ‘hiccups’. But a stark absence of physiologic purpose further invites palliation. Third, the mundane, often self-limited nature of hiccups results in the trivialisation of symptoms. Who has not had hiccups? They occur even in utero.3 When asking for help with hiccups, patients sometimes sound even apologetic, but, as healthcare providers, we must try to help.
The first step: assessment
Assessment and palliation should occur concomitantly, but with respect to the former, healthcare providers should begin by asking two, interrelated questions. What is causing the hiccups? What has been their duration? First, hiccups are most often caused by benign circumstances, such as a distended stomach from overeating or from drinking a carbonated beverage too quickly; and they resolve quickly. Thus, hiccups often go unmentioned in the clinic. Notably, gastro-oesophageal reflux symptoms are common, although controversial with respect to hiccup cause and effect.4 Nonetheless, if a …
Footnotes
Contributors Dr. Jatoi conceived and wrote the manuscript.
Funding Dr Jatoi is the Betty J Foust, MD, and Parents’ Professor of Oncology and used funds from this endowed professorship for this work.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.