Dear Ask The Doctor: I have had hiccups for three days. I had a similar encounter in 2006 which lasted 9 days. I have had several instances dating as far back as 1995, where I had bad enough chest pain to go to a cardiologist for a stress-test, all of which came back "fit-as-a-fiddle". I suspect I may have a hiatal hernia, which is causing both the chest pain and the chronic hiccups. What are your thoughts?
Dear Patient: Hiccups are a common and usually transient condition affecting almost all people in their lifetime. Rarely, hiccups become intractable and can lead to adverse outcomes. A hiccup is an involuntary, intermittent, spasmodic contraction of the diaphragm and intercostal muscles. The exact mechanism provoking hiccups remains unknown. Hiccups involve unilateral contraction of the left hemidiaphragm in approximately 80 percent of cases. Hiccup bouts are usually caused by gastric distention from overeating, carbonated beverages, aerophagia (eg, swallowing with chewing gum or smoking), and gastric insufflation during endoscopy. Other causes include sudden changes in ambient or gastrointestinal temperature or excessive alcohol ingestion. Sudden excitement or other emotional stress can also precipitate hiccups. Irritation of the vagus and phrenic nerve are common causes of persistent or intractable hiccups and could be caused by pharyngitis, laryngitis, goiters, tumors, mediastinal masses, and abnormalities of the diaphragm that irritate the phrenic nerve. Laboratory tests to consider in patients with persistent or intractable hiccups include a complete blood count, electrolytes, blood urea nitrogen (BUN), creatinine, calcium, liver function tests, and amylase/lipase. Other tests your doctor could oreder are an upper endoscopy, MRI, bronchoscopy, esophageal manometry and pulmonary function tests. The specific illness causing the hiccups, if known, should guide the choice of treatment.