Hiccups Research Articles

A Middle-Aged Patient Living with HIV (PLHIV), Presented with Persistent Hiccups, Imbalance, and Multifocal Myoclonus Secondary to Disseminated Tuberculosis

AbstractA middle aged male presented with chronic diarrhoea, persistent hiccups and unsteadiness while walking. His illness had subacute onset and progressive course. Clinically patient had cachexia, pallor, oral thrush and hepatosplenomegaly. On neurological examination, he had fine tremors, gait ataxia, and multifocal myoclonus. Investigations revealed normochromic normocytic anemia, transaminitis, hyponatremia and cerebrospinal fluid pleocytosis(lymphocytic predominance). Brain MRI revealed diffuse patchy meningeal enhancement; CECT abdomen showed circumferential bowel wall thickening, hepatosplenomegaly and necrotic lymphadenopathy. CECT chest exhibited mediastinal lymphadenopathy alongwith centrilobular nodular opacities. Sputum GeneXpert® was positive for mycobacterium tuberculosis with sensitivity to rifampicin. His serology for human immunodeficiency virus was positive. He was diagnosed as disseminated tuberculosis with tuberculer meningitis which caused persistent hiccups, gait abnormaliy and multifocal myoclonus. His symptom resolved with anti tubercular therapy. We aim to highlight here that myoclonus is a rare occurrence with tubercular meningitis.

Chronic hiccups: diagnosis and treatment

Chronic hiccups, lasting more than 48 hours, are a medical condition that remains challenging in both diagnosis and treatment. They can be the sole symptom of a serious underlying disorder, and should therefore not be overlooked, although gastroesophageal reflux disease (GERD) constitutes their most prevalent cause. Chronic hiccups mandate a comprehensive etiological assessment. Treatment strategy may include physical, pharmacological and interventional approaches, as described in literature, particularly when direct causal treatment is unattainable.

Forced inspiratory suction and swallow tool (FISST): an automation of Valsalva maneuver variants for therapeutic interventions

ABSTRACT Introduction The Valsalva maneuver and its modifications have been utilized across several conditions in medicine; however, there have been difficulties in its application. Thus, at the University of Texas Health Science Center in San Antonio, we designed and patented an affordable and accessible device that mimics Valsalva called “Forced Inspiratory Suction and Swallow Tool (FISST). Areas Covered In this review, we discuss the premise for the design of FISST, based on applications of the law of conservation energy, the continuity equation, and Bernoulli’s principle. We then detail the mechanism by which FISST stimulates hiccup cessation by increasing negative inspiratory pressure when drinking through the apparatus, causing diaphragmatic contraction and disruption of the hiccup reflex. We then detail the efficacy and future applications of FISST in addressing other pathologies. Expert Opinion FISST has been used to address hiccups by utilizing its reverse-Valsalva effect to increase parasympathetic stimulation by increasing vagal tone. In a prospective study that we conducted on a cohort of 249 hiccup subjects worldwide, this tool achieved 92% effectiveness. Additionally, several cases, including a published case report, have found FISST successful in terminating supraventricular tachycardias (SVT). FISST may be further utilized in diagnosing or addressing various upper airway pathologies and should be explored further.

Hiccups of Neurological Origin: A Case Report

Hiccups are most often benign and short-lived, but they can also be persistent (> 48h) or even refractory (> 1 month). In these cases, it impairs qualitý of life and can have serious health consequences. We report the case of a patient who consulted for chronic hiccups with absences and in whom the neurological origin was confirmed on brain MRI.

What to do when hiccups are coming? A case report

Hiccup known as innocuous symptom and usually self-limiting within seconds or minutes. The process of hiccup related to involuntary movement, intermitent and repetitive contractions of diaphragm and lead to abrupt early closure of glottis. We report a case of 57-year-old man with 5 days chronic hiccup, following with coughing, nausea, vomiting and seizure. Patient was hospitalized 4 days and getting better after given antibiotic, proton pump inhibitor (PPI) therapy and symptomatic drug due to hiccup.

A Management of Chronic Frequent Hiccup by Kankasava

Hikka is a disease of serious nature and can cause death if not treated properly. The general causative factors include dietary and environmental pathogens and specific pathogenesis is due to involvement of vata and kapha as major dosha. Thus five types of Hikka are elaborated. The classification is based upon clinical presentation of disease and includes three types each of Hikka with bad prognostic signs pointing to worse condition. The description comprehends basic principles of management focused on removing obstruction of kapha and allowing proper flow of vata by means of purification therapies, sudation, nasal errhines, medicated smoking and various formulations. The management emphasizes on nourishment and pacification therapies to successfully treat and prevent the Hikka conditions. Depletion therapies are strongly contraindicated as they may worsen the condition of patient and disease. A 60 years old patient came in opd with complaint of frequent hiccup since 1 month. He has taken allopathic medicine for this but found no result. The condition was managed by Kanakasav 40 ml BD with leuke warm water before meal internally and got instant result. Within one day he became normal.

Baclofen for hiccups: a large mixed methods multisite study

ObjectiveHiccups can be bothersome and spawn morbidity. Although oral baclofen is perhaps the most prescribed agent for hiccups, a paucity of data supports its use.MethodsThis multisite, single institution study examined...

WPersistent Hiccup Reflex Activation for Two Days as a Complication of Dental Implant Surgery: A Case Report

WPersistent Hiccup Reflex Activation for Two Days as a Complication of Dental Implant Surgery: A Case Report

S2331 High-Potency Proton Pump Inhibitor Therapy for the Management of Chronic Hiccups

S2331 High-Potency Proton Pump Inhibitor Therapy for the Management of Chronic Hiccups

Treatment of refractory chronic hiccups. Systematic review of the literature and Presentation of a clinical case treated with electrical modulation.

Aun con su poca incidencia, el hipo crónico refractario presenta un desafío frente al diagnóstico etiológico que puede ser la clave para el tratamiento del mismo. Proponemos una revisión del diagnóstico y del tratamiento actual e igualmente una revisión sistemática de la literatura con los comparadores de manejo farmacológico vs neuromodulación eléctrica en sus diferentes modalidades. Finalmente se reporta un caso tratado con modulación eléctrica del nervio frénico.

Take a deep breath

Suck up your hiccups For most of us, hiccups are usually a temporary annoyance. The problem comes when the annoying spasms just won’t quit. Being shocked or surprised, breathing into a paper bag, or drinking from the wrong side of a glass are all well-known folk remedies for hiccups, but recently, a new solution has come onto the market—a reusable drinking straw. The inventors say this could be a game changer for people with chronic hiccups. Hiccups are involuntary contractions of the diaphragm and the muscles between the ribs. The spasms pull air into the lungs, forcing the voice box open and . . . hic! Doctors know that two nerves—the phrenic nerve and the vagus nerve—are responsible. So Ali Seifi , a physician at the University of Texas Health Science Center at San Antonio, decided to develop a solution that would engage both the nerves involved. Seifi tells Newscripts

A report of use of baclofen in intractable hiccups

IntroductionHiccups are an involuntarily powerful spasm of the diaphragm, followed by a sudden inspiration with a closure of the glottis. Hiccups lasting longer than one month is termed intractable hiccups. Intractable hiccups can be caused by structural or functional disturbances of the medulla, afferent or efferent nerves to the respiratory muscles or metabolic and endocrine disorders, drugs, general anaesthesia and emotional problems.ObjectivesAuthors present a case report about curing a patient of intractable hiccups using baclofen along with literature review.MethodsA case report along with literature review forms the basis of discussion.ResultsA 30-year female diagnosed with schizophrenia stable on 2mg risperidone for 3 years presented to the outpatient department with complain of intractable hiccups for 6 months. Frequency of hiccups was around 10-12 times per minute and continued throughout the day leading to significant socio-occupational distress. patient had been receiving medical treatment for last 4 months for the same including Metoclopramide, chlorpromazine along with trying breath holding and drinking cold water but symptoms persisted. Her ECG, chest X-ray, complete blood counts were unremarkable, CT scan of brain was normal. Patient was started on baclofen 10mg thrice daily. Within 1-week patient had dramatic response and complete remission was achieved in 2 weeks.ConclusionsBeclofen is effective in hiccups because it is an analogue of GABA, that decreases excitability and inhibits the hiccup reflex, which reduces synaptic transmission. Baclofen is used to treat hiccups, and can be used either as a first-line treatment or if patient does not respond to other medications.DisclosureNo significant relationships.

Hiccups, a Rare Presentation of Infective Endocarditis: A Case Report

Hiccup has a wide variety of etiologies irritating the hiccup reflex arc. It is usually benign and self-limited but can be an alarm sign for serious underlying conditions. Hiccup has been rarely reported in patients with infective endocarditis as a result of splenic involvement and phrenic nerve irritation. Herein, we report a 72-year-old man with the chief complaint of long-lasting hiccups (for a 1-month duration) who was diagnosed with infective endocarditis; however, his spleen was grossly intact. The bouts of hiccups repeated 2-3 times a day and lasted for 10-20 minutes. After the initiation of antibiotics, his symptoms waned for a while and appeared again, and then, the hiccups were eliminated. Long-lasting hiccups can be a presentation of serious medical conditions such as infective endocarditis, with or without splenic involvement. Hence, it is important to keep in mind these conditions to perform proper diagnostic and therapeutic workups.

Aristophanes's Hiccups and Erotic Impotence

Aristophanes's Hiccups and Erotic Impotence

SARS-CoV-2 Infection (COVID-19) Revealed by Persistent Hiccups: A Case Report

Hiccups are a ventilatory mechanism involuntarily involving the inspiratory muscles and the glottis, Its physiological interest has not been demonstrated until today. Acute or chronic hiccups have a wide variety of etiologies. We report the case of a 50-year-old patient with a history of iterative sinusitis, who consulted a gastroenterologist for persistent hiccups. The patient's clinical examination was normal. Chest x-ray showing an abnormal mediastinal image leads to a chest CT scan showing a typical picture of COVID-19 virus infection: bilateral and peripheral frosted glass opacities. A nasal swab RT-PCR test confirmed the diagnosis. Admitted to an isolation unit, the patient received treatment with clinical and biological monitoring. The hiccups disappeared around the 3rd day of hospitalization, the negativation of the RT-PCR occurring after 14 days with a favorable evolution of the symptoms. To our knowledge, this is the 2nd global case of persistent hiccups that has revealed infection with the COVID-19 virus.

Identification of Phenolic Constituents and Inhibitory Activity of Persimmon Calyx and Shiteito against Tumor Cell Proliferation.

The persistent calyx on the fruit of Diospyros kaki, called "Shitei" in Japanese, is reported to contain phenolic compounds including condensed tannins. In this study, we isolated and characterized a new compound, together with 26 phenolic components, from the 70% acetone extract of Shitei, with structural elucidation based on spectroscopic analyses. In addition, we confirmed the presence of condensed tannins by 13C-NMR spectra, and the weight-average molecular weight was estimated by gel permeation chromatography (GPC) analysis. Next, Shiteito, a Kampo medicine consisting of Shitei, ginger, and clove clinically used to treat chronic hiccoughs occurring in association with anticancer drug treatments, and hot-water extracts of each of its components, were analyzed by HPLC, which determined that the main ingredient in Shiteito was derived from clove. We therefore isolated the ingredients and investigated their anti-tumor cell proliferative activity, together with Shiteito and Shitei extracts. As a result, Shiteito showed weak inhibition of hepatocellular carcinoma (Hep3B) cell proliferation at a high concentration. In contrast, ellagic acid, one of the main constituents of Shiteito, showed significant cytotoxicity against Hep3B cells, and significant inhibition of gastric adenocarcinoma (AGS) cell proliferation in a concentration-dependent manner. The ethyl acetate (EtOAc) fraction of the 70% acetone extract of Shitei significantly inhibited the proliferation of colon adenocarcinoma (Caco-2) and AGS cells at low to middle concentration, while showing strong cytotoxicity against Hep3B. These data indicate that Shiteito and Shitei extracts could enhance cancer drug treatment by preventing the associated chronic hiccups, and have the potential to be adjuvant treatments as well.

Causa infrecuente de hipo crónico

El hipo crónico es un síntoma que puede provocar una invalidez significativa y a menudo revela una enfermedad subyacente. A continuación, se presenta el caso de un varón de 68 años que ingresó con hipo de más de 3 meses de duración que se asociaba con epigastralgia, vómitos posprandiales y pérdida ponderal. Había sido intervenido en 2 ocasiones debido a una enfermedad por reflujo gastroesofágico y hernia hiatal, una primera en la que se realizó una fundoplicatura y, posteriormente, una reintervención consistente en el cierre de los pilares diafragmáticos y re-Nissen laparoscópico. La clínica se debía a una obstrucción hiatal por acodamiento de la fundoplicatura previa y fue resuelta mediante la reposición hiatal a los parámetros anatómicos y desmontaje del Nissen previo.

Hiccups triggered by bladder filling after bilateral pontine hemorrhage

Introduction:A hiccup is myoclonus of a sudden involuntary contraction of the diaphragm. Hiccups have various causes, and brain stem stroke is one of the causes of central hiccups. Certain types of hiccups are caused by diseases that can be fatal. Therefore, it is beneficial for physicians to be familiar with the various cases of unusual hiccups. We report a case of hiccups triggered by urinary bladder filling in a brain stem stroke patient. To the best of our knowledge, previous reports have not described a similar case.Patient concerns:We describe the case of a 54-year-old patient who had acute bilateral pontine hemorrhage. The patient had intermittent hiccups in the early stages of the stroke onset. The hiccups ceased by the administration of medication or stimulation of the pharyngeal or tracheal wall. Two months after the onset, the Foley catheter was removed to check if the patient could void the bladder voluntarily. Hiccups occurred whenever the bladder was filled with some amount of urine.Diagnosis:Pontine hemorrhage, neurogenic bladder, and quadriplegia.Interventions:When the hiccups occurred, the amount of urine in the bladder was checked using a transabdominal bladder ultrasonography scanner. After clean intermittent catheterization for bladder emptying, the hiccups subsided.Outcomes:The hiccups occurred 5 or 6 times a day, as often as the bladder was filling. He was unable to void the urine voluntarily for 5 days after the removal of the Foley catheter. Percutaneous suprapubic cystostomy was performed finally to remove the stimulation of bladder filling and the hiccups disappeared.Conclusion:Bladder filling is suspected to increase the sympathetic tone and cause a hiccup reflex. Bladder filling could be a factor triggering hiccups in pontine hemorrhage.

Chronic Hiccups.

Nearly 4000 patients will be admitted to hospital in the US this year for hiccups. Hiccups are controlled by a complex reflex arc between peripheral receptors and the brainstem. Any disruption along this pathway may produce hiccups. Typically, hiccups resolve spontaneously but in certain pathologies symptoms may persist. Persistent hiccups may be considered a sign of underlying pathology. The most common cause involves GERD. Based on etiologies, studies have shown that first-line therapy should use a proton pump inhibitor (PPI) and involve appropriate gastrointestinal consultation. If symptoms persist, other etiologies such as central causes need to be explored. We review the pathophysiology of hiccups including multiple causes and the appropriate work up for each. We review several studies examining new treatments, both pharmacological and interventional, that may help patients. Initial therapy should still involve a PPI but several new therapies may be beneficial.

The minimum local anesthetic concentration of ropivacalne for ultrasound-guided phrenic nerve block in the treatments of central hiccup

Objective To determine the minimum local anesthetic concentration of ropivacalne for ultrasound-guided phrenic nerve block in the treatments of central hiccup. Methods In this experiment, sequential experimental method was used to select patients with hiccup after the operation of cerebral hemorrhage. The starting concentration of ropivacaine was 0.25%. The ratio between adjacent concentrations was 1.3. The superficial phrenic nerve on the left anterior scalene muscle of all patients were located by ultrasound. The predetermined concentration of ropiacaine 4 ml was injected. After twenty minutes, whether the injection works or not was judged by observing the symptom of all patients. If the first one is effective, the next injection dose will be decreased one concentration gradient. If the block was not effective, then 4 ml of 1.5% lidocaine will be injected at the same lateral phrenic nerve. If the block is still not effective, the next injection will be ropivacaine with increased one concentration gradient. If the hiccups still did not end, the routine drug treatment will be used. At the same time, with the approval of the patients′ family, after eight hours, we will take the right phrenic nerve block. Then this case will not be included in the data statistic. The next patient continues to use the same initial concentration ropivacaine. The effective cases were included in effective group(group A) while the cases with lidocaine supplement were divided into invalid group (group B). The drug concentration, blocking effect, median effective dose(ED50) and 95% confidence intervals (CI) were calculated according to Dixon and Brownlee methods. Results Ultrasound-guided application of ropivacaine for phrenic nerve block for central hiccup is safe, effective and requires little medication. 95%CI of ultrasound-guided phrenic nerve block for central hiccup is 0.267%-0.335%. Conclusions The minimum effective concentration of ropivacaine in the treatment of central hiccup was 0.299%. Key words: Phrenic nerve; Nerve blocking anesthesia; Hiccup; Ultrasound-guided; Ropivacaine