hiccup

and Carola Felchner, science journalist

Carola Felchner is a freelance writer in the medical department and a certified training and nutrition advisor. She worked for various specialist magazines and online portals before becoming a freelance journalist in 2015. Before starting her internship, she studied translation and interpreting in Kempten and Munich.

More about the experts All content is checked by medical journalists.

Hiccups (mediz .: Singultus) are annoying, but mostly harmless and go away by themselves after a few minutes. The cause of the hiccups is still unclear. Hiccups may be a protective reflex that helps babies develop. Adults, on the other hand, do not seem to benefit from the singultus. In rare cases, illnesses that should be treated are behind the hiccups.Find out here what causes hiccups can have and the best way to get rid of them.

Brief overview

• Description: Hiccups (Singultus) is a hiccup that can occur four to 60 times per minute
• Cause: Jerky contraction of the diaphragm, which results in a sudden, deep inhalation with the glottis closed - the breath ricochets off and the sound of hiccup occurs.
• Trigger: e.g. B. Alcohol, hot or cold food and drinks, hasty eating, diseases such as inflammation (in the stomach, esophagus, larynx, etc.), reflux disease, ulcers and tumors
• When to the doctor If the hiccups persist or recur frequently, you should see your family doctor or general practitioner to rule out an illness as the cause.
• Diagnostics: discussion with the patient, physical examination, if necessary further examinations such as x-rays, bronchoscopy, blood tests, etc.
• Therapy: Most hiccups do not require treatment because they go away on their own. Otherwise, tips such as holding your breath or drinking water in small sips help. The doctor sometimes prescribes medication for chronic hiccups. Breathing training, behavior therapy, and relaxation techniques may also make sense.

Hiccups: causes and possible diseases

The diaphragm cramps suddenly when the hiccups occur. As a reaction to this, the crack between the vocal cords closes so that the air can no longer escape. Then a pressure builds up, which is discharged in the characteristic hiccup.

The main responsible for this reflex of the diaphragm is the diaphragmatic nerve Phrenic nerve and the cranial nerve N. vagusthat are sensitive to certain external stimuli. This can include food that is too hot or too cold, swallowing too quickly, alcohol or nicotine. However, various diseases can also trigger hiccups via the aforementioned nerves or directly via the diaphragm.

If the hiccups last longer than two days, it is called chronic hiccups. Often no cause can be found.

General triggers of hiccups

• hasty eating and swallowing
• very full stomach
• hot or cold food or drinks
• carbonated drinks
• alcohol
• nicotine
• Stress, excitement, tension, or fear
• depressions
• Pregnancy when the embryo presses against the diaphragm
• Surgery on the abdomen that irritates or affects nerves
• Gastroscopy, which irritates the larynx and the nerves there
• some medications, such as anesthetics, sedatives, cortisone supplements, or anti-epileptic drugs

Diseases as a cause of hiccups

• Inflammation of the stomach and intestines (gastroenteritis)
• Inflammation of the lining of the stomach (gastritis)
• Inflammation of the pancreas (pancreatitis)
• Inflammation of the gullet (esophagitis)
• Inflammation of the larynx (laryngitis)
• Sore throat (pharyngitis)
• Pleurisy (pleurisy)
• Inflammation of the pericardium (pericarditis)
• Inflammation of the brain (encephalitis)
• Meningitis

• Reflux disease (chronic heartburn)
• Damage to the diaphragm (e.g. diaphragmatic hernia)
• Stomach ulcer
• Traumatic brain injury or cerebral hemorrhage, increased intracranial pressure
• Overactive thyroid gland (hyperthyroidism)
• Liver disease
• Diabetes or other metabolic disorders
• Heart attack
• stroke
• Kidney failure or kidney disorders
• multiple sclerosis
• Tumor of the esophagus, stomach, lungs, prostate, brain, or in the ear or throat
• enlarged lymph nodes (stomach / chest area)

Hiccups in children

It's not just adults who hiccup: babies and toddlers can hiccup too. Often they do this more often than teenagers and adults. Even in the womb, unborn babies can have hiccups, which mothers sometimes feel.

Why this is so has not been conclusively clarified. Some researchers suggest that hiccups in babies prevent water or food from getting into the lungs - it would be a protective reflex. According to another theory, the hiccup in babies trains the respiratory system before and after birth. Or the hiccups help to get air out of the baby's stomach to make it easier for milk to be absorbed.

What helps against hiccups?

Most of the time, the hiccups go away on their own. What you can do yourself with hiccups, there is a lot of advice around: drink a glass of water, put a spoonful of vinegar with sugar in your mouth and swallow slowly or let yourself be frightened - the tips and home remedies for hiccups are as varied as they are adventurous. And almost all of them lack a scientific basis. Still, they can help calm your breathing and loosen up the tense diaphragm.

For example, if you drink a glass of water in small sips, you automatically hold your breath. The same goes for the vinegar with sugar, which melts on the tongue and is swallowed slowly. Other tips against hiccups include sticking out your tongue or rolling backwards for a few breaths. This ensures that breathing is stronger through the abdomen and becomes calmer. The spasm in the diaphragm can resolve.

Such breathing regulation can also be achieved by holding your breath or breathing into a bag. This technique increases the concentration of carbon dioxide (CO2) in the blood, which provokes deep, more even breathing. But be careful, this can quickly lead to circulatory problems and even loss of consciousness!

The so-called Vasalva method, which also relieves pressure on the ears, can help against hiccups: hold your nose, close your mouth and then tighten your breathing muscles as if you were exhaling. The pressure bulges the eardrum outwards and compresses the chest cavity. Maintain this pressure for around ten to 15 seconds. The same applies here: Do not overdo it with the pressure and duration of the exercise.

If you often react to cold, hot or spicy food and drinks with hiccups, you do not necessarily have to do without them completely. Instead, you should take extra care to breathe calmly and evenly while eating and drinking. You should also sit relaxed and upright.

What helps against chronic hiccups?

If chronic hiccups are caused by an illness, the doctor will first treat it, for example with medication. For example, he can prescribe acid inhibitors (proton pump inhibitors) that fight heartburn. In other cases, the patient benefits from a muscle relaxant (baclofen), an anti-nausea drug (domperidone), or a drug that promotes gastrointestinal function (a so-called prokinetic).

Some patients may also be helped by certain anti-epileptic drugs (anti-epileptic drugs), such as gabapentin or carbamazepine. Depending on the cause of the hiccups, the doctor may recommend sedatives, neuroleptics, or cannabis products, for example.

Chronic hiccups without an identifiable cause (idiopathic hiccups) can also be partially treated with medication.

As an alternative or in addition to drug treatment, breathing training or behavior therapy may help. In these courses, those affected learn both to prevent hiccups and to drive away any hiccups. The same purpose also pursue various relaxation techniques, with which the out of control diaphragm can be calmed down again.

Hiccups: when do you need to see a doctor?

Hiccups are usually not harmful to your health. However, if it lasts for a very long time, it can be extremely stressful for those affected. Many then develop insomnia or depression or lose weight. In addition, persistent or recurring hiccups can indicate an underlying illness. You should therefore see a doctor if you have hiccups regularly or for more than 48 hours at a time - the hiccups are chronic.

Call an emergency doctor immediately if symptoms such as headache, visual disturbances, impaired speech, symptoms of paralysis, nausea or dizziness occur in addition to the hiccups. It could then be a stroke that needs immediate treatment!

Hiccups: what does the doctor do?

The first port of call for chronic or frequent hiccups is the family doctor or general practitioner. He will first get a more detailed picture of the complaints and possible causes through the patient interview (anamnesis). Possible questions are:

• When did the hiccups occur?
• How long did it last and how quickly did it return?
• How did you experience the hiccups, how severe were the hiccups?
• Did you have to burp too?
• Do you consider common triggers of Singultus, such as cold meals, hasty meals, alcohol or cigarettes?
• Are you currently suffering from stress or other psychological stress?
• Do you take any medicine? If so, which ones and how often?

A physical examination follows after taking the medical history. The doctor is primarily interested in the abdomen, chest, throat and heart; he listens to the lungs, checks the breathing and tests the nervous system including the reflexes.

This sometimes leads to a suspicion of what is causing the hiccups. To confirm the diagnosis, the doctor can carry out further examinations or refer the patient straight away to a specialist, for example an internist, gastroenterologist, neurologist or endocrinologist. The further examinations depend on the specific suspicion of the disease. The following are among others:

• pH measurement or trial therapy with acid inhibitors if reflux is suspected
• Esophagus and gastroscopy (gastroscopy) to rule out reflux disease or a gastric ulcer, among other things
• Ultrasound examination of the neck and abdomen
• X-ray of the chest and abdomen
• Respiratory function test to determine irregularities in the respiratory muscles and especially in the diaphragm and to check lung activity
• Bronchoscopy (bronchoscopy)
• Blood tests for inflammation markers and any deficiency symptoms
• Electrocardiography (EKG) and cardiac ultrasound (echocardiography), if the heart might be involved
• Computed tomography (CT) of the neck and chest area
• Removal of nerve fluid (lumbar puncture) if there is suspicion of inflammation of the nerves or the meninges
• Electroencephalography (EEG) for suspected nervous system disorders
• Magnetic resonance imaging (MRI) or computed tomography (CT) if nerve damage is suspected
• Ultrasound (Doppler sonography) of the blood vessels in the event of a possible heart attack or stroke

If no cause for the hiccups can be found, the doctor speaks of idiopathic chronic hiccups. But it is quite rare.

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