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


Alcohol or nicotine


Emotional stress or sudden psychological shock

Causes of chronic hiccups (persistent and intractable)


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


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


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)


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


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


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


(e.g., ice water, granulated sugar)

Induced vomiting

Strong Traction on the Tongue

Jan 31, 2018 | Posted by in ABDOMINAL MEDICINE | Comments Off on Chronic Belching and Chronic Hiccups

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