Belching, Air Swallowing, and Hiccups
Belching, Air Swallowing, and Hiccups
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The classic treatment of hiccups from a pharmacologic standpoint is chlorpromazine, 25 mg given 3-4 times daily, or haloperidol. Side effects are common with chlorpromazine.
Other pharmacologic agents that have been tried include baclofen and the gamma-aminobutyric acid (GABA) agonist gabapentin, and they might provide nominal benefit. It is helpful to pinpoint the underlying cause before targeting therapy.
Some patients have benefited from hypnotherapy and biofeedback. Mechanical maneuvers are often tried, such as bearing down, breath-holding, eyeball stimulation, carotid stimulation, drinking water upside-down, and so forth. The mechanisms of those maneuvers involve vagal stimulation and hypercapnia. Nasopharyngeal stimulation may have some vagal effect as well.
Some techniques have short-term benefit. Granulated sugar was suggested in 1971 in a letter to the Editor of the New England Journal of Medicine. In 1954, my grandparents were telling us to take sugar for hiccups; maybe it is an old Swedish remedy. They mixed it with vinegar. Vinegar has also been used intranasally for hiccups, which sounds fairly radical. The Swedish put a teaspoon of sugar into vinegar and swallowed it. The granulation probably stimulates vagal afferents.
When patients present with belching, aerophagia, or hiccups, think about these symptoms in a very specific fashion. Remember the behavioral aspects of belching and aerophagia, and that hiccups are the tip of the iceberg for significant pathology.
Hopefully, this discussion has been helpful. I look forward to talking with you again.
Management of Hiccups
[ CLOSE WINDOW ]
(Enlarge Slide)
The classic treatment of hiccups from a pharmacologic standpoint is chlorpromazine, 25 mg given 3-4 times daily, or haloperidol. Side effects are common with chlorpromazine.
Other pharmacologic agents that have been tried include baclofen and the gamma-aminobutyric acid (GABA) agonist gabapentin, and they might provide nominal benefit. It is helpful to pinpoint the underlying cause before targeting therapy.
Some patients have benefited from hypnotherapy and biofeedback. Mechanical maneuvers are often tried, such as bearing down, breath-holding, eyeball stimulation, carotid stimulation, drinking water upside-down, and so forth. The mechanisms of those maneuvers involve vagal stimulation and hypercapnia. Nasopharyngeal stimulation may have some vagal effect as well.
Some techniques have short-term benefit. Granulated sugar was suggested in 1971 in a letter to the Editor of the New England Journal of Medicine. In 1954, my grandparents were telling us to take sugar for hiccups; maybe it is an old Swedish remedy. They mixed it with vinegar. Vinegar has also been used intranasally for hiccups, which sounds fairly radical. The Swedish put a teaspoon of sugar into vinegar and swallowed it. The granulation probably stimulates vagal afferents.
When patients present with belching, aerophagia, or hiccups, think about these symptoms in a very specific fashion. Remember the behavioral aspects of belching and aerophagia, and that hiccups are the tip of the iceberg for significant pathology.
Hopefully, this discussion has been helpful. I look forward to talking with you again.
