Chronic Belching and Chronic Hiccups

Causes of acute, benign hiccups

Esophageal and Gastric distention

Aerophagia, retained food, carbonated drink, rapid gorging

Sudden temperature change

Cold shower, hot/cold food or drink, rapid environmental shift

Intoxication

Alcohol or nicotine

Psychogenic

Emotional stress or sudden psychological shock

Causes of chronic hiccups (persistent and intractable)

Neurologic

Traumatic, infectious, vascular, multiple sclerosis, Parkinson’s, tumor

Toxic/metabolic

Uremia, diabetes, electrolyte abnormalities (esp. Hypocarbia), fever

Drugs/medications

General anesthesia, alpha methyldopa, corticosteroids, benzodiazepines

Irritation, vagal

Pharyngeal, auricular, thoracic, abdominal, or recurrent laryngeal branches

(i.e., irritation of almost any internal organ connected to the vagus nerve)

Esophageal

Gastroesophageal reflux disease (GERD), large hiatal hernia, foreign body, tumor

Diaphragmatic

Myocardial infarction, pericarditis, hernia/eventration, abscess, hepatitis

Aerodigestive

Gastric distention, visceral traction, mis-ventilation, glottic stimulation

This Is Really Annoying. How Do I Make It Stop?

By the time someone presents for treatment, they have typically already tried the usual home remedies, Table 22.2. These, however, are often worth reviewing and even trying again in the office. They generally involve little time or risk.

Table 22.2

Physical (home) remedies for hiccups

Nasopharyngeal stimulation	Vagal stimulation	Respiratory maneuvers
Intra-nasal vinegar or catheter	Cold compress to face	Breath hold (stacked inspiration)
Inhalation of stimulant/irritant	Carotid massage	Re-breathing (hypercapnia)
(e.g., ammonia, “smelling salts”)	Induced fright	Valsalva maneuvers
Oropharyngeal stimulation	CPAP-respiration
(e.g., ice water, granulated sugar)	Induced vomiting
Strong Traction on the Tongue