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At least 19 recordsLinked to original sources
PubMedDate not supplied

The hiccup reflex arc and persistent hiccups with high-dose anabolic steroids: is the brainstem the steroid-responsive locus?

Hiccups have been classified as a neurologic reaction triggered by a multitude of factors. There are only a few reports of persistent hiccups associated with oral and intravenous corticosteroid use in the medical literature. It has been proposed that corticosteroids lower the threshold for synaptic transmission in the midbrain and directly stimulate the hiccup reflex arc. There is a recent report of progesterone-induced hiccups, which were thought to occur secondary to the glucocorticoid-like effects of progesterone on the brainstem. We report the first case of anabolic steroid-induced hiccups occurring in an elite power lifter. The hiccups occurred within 12 hours of the individual increasing his doses of oral anabolic steroids and persisted for 12 consecutive hours until medical attention was sought. In this report the pathophysiology of anabolic steroid-induced hiccups is discussed, and the postulated relationships of steroids and the hiccup reflex arc reviewed.

Administration, Oral↗
PubMedDate not supplied

Hiccup and apparent myoclonus after hydrocodone: review of the opiate-related hiccup and myoclonus literature.

The author recently encountered a patient with hiccups, intermittently accompanied by apparent focal rhythmic diaphragmatic myoclonus after hydrocodone administration. Review of the literature disclosed a paucity of previous reports of hiccup, but many reports of myoclonus after opiate administration. A wide variety of opiates and routes of administration have been implicated, but high doses and the presence of other agents (antipsychotics, antiemetics, nonsteroidal antiinflammatory agents, antidepressants) may pose special risks. Review of the literature suggests three types of opiate-related myoclonus. Opiate-induced myoclonus (OIM) is often generalized and is either periodic or associated with rigidity. Opiate-induced myoclonus frequently occurs in the context of underlying medical conditions, D2 antagonist coadministration, or other drugs (nonsteroidal anti-inflammatory agents, antidepressants), and usually responds to either naloxone or benzodiazepines. Intrathecal OIM has not been linked to D2 antagonist coadministration or benzodiazepine responsiveness but may be associated with non-steroidal antiinflammatory agents. Opiate withdrawal myoclonus may be stimulus-sensitive, associated with D2 antagonist coadministration, and responsive to benzodiazepines and unresponsive to naloxone. There are several problems in interpreting the literature, and more study is needed. Opiatergic, serotonergic, dopaminergic, and other mechanisms are considered.

Analgesics, Opioid↗
PubMed2000

Linkage of hiccup with heartbeat.

We explored a possible link between the cardiac cycle and the timing of recurrent hiccups in 10 patients with chronic, intractable hiccups. Recordings made during daytime naps in a sleep laboratory included sleep state; electrocardiogram; and respiration by means of a thermistor to detect airflow, bands around the rib cage and abdomen to assess expansion, and a bipolar surface electrode electromyogram over parasternal intercostal muscles. Hiccups could be detected on the abdominal bands and the parasternal electromyogram. The time of occurrence of each hiccup and each R wave in a continuous tracing of 100 or more hiccups were recorded and analyzed together with semiquantitive estimates of the phase of hiccup respiration. Whereas the hiccup rate ranged from approximately one-third to one-eighth of heart rate and was more variable than heart rate, hiccups showed a tendency, stronger in some subjects than others, to occur in midsystole. Variation in R-wave-R-wave (R-R) interval in association with hiccups was found in five patients. In three of these patients, hiccups were synchronized with respiration so that the cyclic change in R-R interval posthiccup could be explained as sinus arrhythmia, but, in two patients, the hiccups were not synchronized with respiration, so that hiccups are most likely responsible for the variation in heart rate. Also, the variation of R-R interval with hiccups suggests that there is some phasic autonomic efferent activity associated with hiccups.

Aged↗
PubMed1978

On temporal structure of human hiccups: ethology and chronobiology.

During a study on the phylogeny and ontogeny of human hiccups, essentially all hiccups to occur over continuous periods of 3m - lly were recorded from 20 healthy people of either sex and various ages. Hiccups displayed considerable structure in time. If more than a few occurred together, they became "established" and a hiccup bout ensued, which did not stop until a certain "minimum" number of hiccups had occurred. For many subjects, two or more bouts frequently occurred on the same hiccup day, even though days on which bouts occurred were weeks apart. Number of hiccups was correlated with age, sex, reproductive status and stage of menstrual cycle, time of day, length of time since previous hiccup day, length of time since previous hiccup bout, and length of hiccup-hiccup intervals within a bout. Findings support the hypothesis that human hiccup is a "fixed action pattern" (FAP)--a central theoretical concept in ethology--and provide leads for further studies aimed at learning the biological function(s) of human hiccup and its possible homologues in other species.

Adult↗
PubMed1980

Hiccups in infants: characteristics and effects on ventilation.

Twenty-seven polygraphic recordings of respiration were obtained on 20 infants, providing data on the frequency, distinguishing features, and medical significance of hiccupping episodes. Eight hiccupping episodes were recorded in seven subjects. The mean duration of the spells was 8.4 +/- 4.2 (SD) minutes. Unintubated subjects, not selected because they were hiccupping, hiccupped 2.5% of the time that they were monitored. Each hiccup was a brief, powerful inspiratory muscle contraction. In unintubated subjects, hiccups were marked by upper airway obstruction, whereas in intubated patients, hiccups were unobstructed inspirations. In unintubated subjects, hiccups were associated with an increase in obstructed eupneic breaths and with decreases in respiratory frequency and minute ventilation; in three subjects hiccups precipitated episodes of mixed apnea. In intubated patients, hiccupping spells were characterized by hyperventilation and respiratory alkalosis. Two types of ECG artifacts were seen with hiccups: high-frequency spikes, mimicking abnormal QRS complexes, and low-frequency waves. From these studies, it appears that hiccups occur frequently in young infants and may affect breathing in clinically significant ways.

Alkalosis, Respiratory↗
PubMed1994

Fetal hiccups in the baboon.

Bouts of hiccuping are recognized by pregnant women as distinct episodic movements of their fetuses. Ultrasound imaging of these fetuses has documented the occurrence of hiccups from early gestation through parturition. This study provides a systematic characterization of prenatal hiccuping in the fetal baboon (Papio species). Tracheal fluid pressure was recorded from 11 chronically instrumented fetal baboons for 21.5 +/- 7.3 consecutive days (mean +/- SD) over a range in gestation from 124 to 164 days (term 175 days). In an initial review of pressure recordings by visual inspection, hiccups were recognized as distinctive high-amplitude fluctuations in tracheal pressure that were readily discriminated from fetal breaths. Automated techniques were then developed and validated to detect hiccups and summarize their features. The mean hiccup amplitude was 23.0 +/- 3.1 mmHg, inspiratory time was 0.26 +/- 0.03 s, and expiratory time was 0.27 +/- 0.02 s. Each of these features discriminated hiccups from breaths (P < 0.001). Hiccuping incidence (1.8 +/- 0.4% of time), rate (26.2 +/- 6.2 min-1), bout duration (4.3 +/- 0.8 min), and the interval between bouts (3.35 +/- 0.60 h) were also different (P < 0.01) from breathing. These features of hiccups remained relatively constant over the latter third of gestation with the exception of an increase in duration of the expiratory time interval (r = 0.54, P < 0.01). Despite their vigorous nature, bouts of hiccuping were not associated with transitions in behavioral state. Moreover, the features of hiccups were not differentiated by state. Bouts of hiccuping recurred in a cyclic fashion, on average every 3-4 h.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1996

Chronic hiccups and sleep.

To explore the effect of sleep on hiccups, we studied eight patients aged 20-81 years, all males with chronic hiccups lasting 7 days to 7 years, by means of overnight polysomnography. The incidence of new bouts of hiccups and the likelihood of hiccups being present were both highest in wakefulness and became progressively lower through stages I-IV of slow wave sleep (SWS) to rapid eye movement sleep (REMS). There was a significant tendency for hiccups to disappear at sleep onset and REMS onset. Of all 21 bouts of hiccups that were observed to stop, 10/21 did so during an apnea or hypopnea. Frequency of hiccups within a bout slowed progressively from wakefulness through the stages of SWS to REMS. For the whole group, mean frequency decreased significantly from wakefulness [(25.6 +/- 12.1), (mean +/- SD)] to sleep onset or stage I (22.3 +/- 12.2). Sleep latency was increased from 8 +/- 16.3 minutes when hiccups were absent to 16.35 +/- 19.9 minutes when it was present. Sleep efficiency was poor because of long waking periods, and there were deficiencies of both SWS and REMS. Hiccups themselves were not responsible for any arousals or awakenings. We conclude that neural mechanisms responsible for hiccups are strongly influenced by sleep state and that hiccups disrupt sleep onset but not established sleep.

Adult↗
PubMed1995

Baclofen therapy for chronic hiccup.

Chronic hiccup is a rare but potentially severe condition, that can be symptomatic of a variety of diseases, or idiopathic. Many therapeutic interventions have been reported, most often as case reports. Among other drugs, baclofen has been suggested as a therapy for chronic hiccup. In a large series of patients, we have evaluated its therapeutic position. In patients with chronic hiccup, defined as hiccup spell or recurring hiccup attacks lasting more than 7 days, investigation of the upper gastro-oesophageal tract (fibroscopy, manometry, and pH monitoring) was systematically performed. Most patients had tried numerous drugs in the past, without success. Baclofen was used as a first treatment in patients without evidence of any gastro-oesophageal disease (n = 17), and was undertaken only after full treatment of such disease (n = 55) had failed to solve the hiccup problem (n = 20). Baclofen has, therefore, been administered to 37 patients with chronic hiccup (average duration 4.6 yrs). Baclofen produced a long-term complete resolution (18 cases) or a considerable decrease (10 cases) of hiccups in 28 of the 37 patients. There was no significant difference between patients with or without gastro-oesophageal disease. We conclude that so-called idiopathic chronic hiccup often results from gastro-oesophageal abnormalities. Also, if controlled studies confirm our encouraging results, baclofen can be a major element in the treatment of chronic hiccup that is idiopathic, or that cannot be helped by treatment of gastro-oesophageal diseases.

Anti-Ulcer Agents↗
PubMed1998

Hiccups with high dose dexamethasone administration: a case report.

BACKGROUND: A 59-year-old male developed intractable hiccups during monthly therapy with high dose dexamethasone for multiple myeloma. Hiccups would begin hours after his first dose and continue over the 4 days of therapy. He sought assistance after his attempt at home remedies failed and the hiccups became exhausting. METHODS: The strong temporal relation between dexamethasone administration and the occurrence of hiccups indicated that dexamethasone was the cause of the patient's hiccups. Because he was responding to dexamethasone, the decision was made to continue therapy and to relieve his hiccups with metoclopramide. RESULTS: Low dose oral metoclopramide allowed the patient to continue therapy without a recurrence of the hiccups. CONCLUSIONS: Dexamethasone administration can result in intractable hiccups that persist for the duration of therapy. Low dose oral metoclopramide may prevent hiccups in patients in whom the discontinuation of dexamethasone therapy is not appropriate.

Antineoplastic Agents, Hormonal↗
PubMedDate not supplied

Hiccups associated with lateral medullary syndrome. A case report.

We present a case of persistent hiccups (singultus) after a lateral medullary cerebrovascular accident. The patient presented with a two-day history of nausea and vomiting. Clinically, the patient had a loss of pain and temperature on the left side of the face, a loss of pain and temperature on the right side of the trunk, a mild left hemiparesis, and a left-sided ataxia. Nystagmus, diplopia, and hiccups were also evident. A left lateral medullary syndrome in the vascular distribution of the posterior inferior cerebellar artery was diagnosed. Work-up included a magnetic resonance imaging angiogram, which revealed an occlusion v high-grade stenosis of the basilar artery. The patient reported that the most distressing symptom was the chronic hiccups (25/min), which interfered with nutrition, sleep, and activity. While in the acute care hospital, the patient was treated with prochlorperazine, promethazine, and chlorpromazine. Each of these medications was unsuccessful in stopping the hiccups. After a search of the European literature revealed that baclofen was recommended as the drug of choice for stopping persistent hiccups, the patient was given 5 mg of baclofen by mouth three times per day, and the hiccups abated within 48 hours. The baclofen was discontinued after one week of therapy, and the hiccups did not return. We recommend consideration of baclofen for the treatment of persistent hiccups after lateral medullary syndrome because of its desirable side effects and reported success rate compared with other drugs used to treat chronic hiccups.

Aged↗
PubMed1997

Stimulus and site specific induction of hiccups in the oesophagus of normal subjects.

BACKGROUND: Hiccups that are induced by a large meal have been suggested to result from gastric overdistension. The role of the oesophagus in precipitating hiccups has never been defined. AIMS: To determine the involvement of oesophageal mechanoreceptors in the hiccup reflex. METHODS: Ten normal healthy subjects were prospectively evaluated at a university affiliated hospital. Controlled inflation of a polyethylene bag in the proximal and distal oesophagus was carried out using slow ramp and rapid phasic distensions, by an electronic distension device. RESULTS: Hiccups were induced in four subjects only during rapid phasic distensions and only in the proximal oesophagus. The mean (SEM) minimal volume threshold for the hiccup reflex was 32.5 (4.8) ml, which was above the perception threshold. Hiccups appeared during inflation and resolved after deflation. CONCLUSIONS: Sudden rapid stretch of the mechanoreceptors in the proximal oesophagus can trigger the hiccup reflex in normal subjects. Only rapid distensions above a determined volume threshold will predictably induce hiccups in a given subject. This mechanism may play a role in the physiological induction of hiccups.

Adult↗
PubMed1997

Effects of transient intrathoracic pressure changes (hiccups) on systemic arterial pressure.

The purpose of the study was to determine the effect of transient changes in intrathoracic pressure on systemic arterial pressure by utilizing hiccups as a tool. Values of systolic and diastolic pressures before, during, and after hiccups were determined in 10 intubated preterm infants. Early-systolic hiccups decreased systolic blood pressure significantly (P < 0.05) compared with control (39.38 +/- 2.72 vs. 46.46 +/- 3.41 mmHg) and posthiccups values, whereas no significant change in systolic blood pressure occurred during late-systolic hiccups. Diastolic pressure immediately after the hiccups remained unchanged during both early- and late-systolic hiccups. In contrast, diastolic pressure decreased significantly (P < 0.05) when hiccups occurred during diastole (both early and late). Systolic pressures of the succeeding cardiac cycle remained unchanged after early-diastolic hiccups, whereas they decreased after late-diastolic hiccups. These results indicate that transient decreases in intrathoracic pressure reduce systemic arterial pressure primarily through an increase in the volume of the thoracic aorta. A reduction in stroke volume appears to contribute to the reduction in systolic pressure.

Blood Pressure↗
PubMed1990

Hiccups: esophageal manometric features and relationship to gastroesophageal reflux.

Gastroesophageal reflux (GER) has been reported to be a cause of hiccups. Conversely, some reports state that hiccups cause or adversely affect GER disease. There have been few descriptions in the literature of what hiccups do to esophageal motility. We present a patient with long-standing symptomatic GER and intractable hiccups. Esophageal manometry during hiccups showed absence of LES pressure and absence of peristaltic activity in the esophageal body in response to swallowing, factors which could aggravate GER. Esophageal motility in the absence of hiccups was normal. Antireflux surgery in our patient relieved heartburn but not hiccups. Based on our case and a review of the literature, we believe that clinicians should be cautious in recommending antireflux surgery to treat hiccups in patients with both hiccups and heartburn.

Aged↗
PubMedDate not supplied

Idiopathic chronic hiccup: combination therapy with cisapride, omeprazole, and baclofen.

Idiopathic chronic hiccup (ICH) is defined as recurring hiccup attacks that last for longer than an arbitrary time limit (eg, 1 month) and for which no organic cause can be found. In patients with ICH, therapy is largely empiric. For practical purposes, idiopathic hiccup can be assumed to have its origin either in the viscera (gastrointestinal tract) or in the central nervous system. Cisapride and omeprazole--through reduction of gastric acid production and facilitation of gastric emptying, respectively--are thought to reduce an assumed afferent input from the periphery to a putative supraspinal hiccup center. Baclofen is thought to reduce excitability and depress reflex hiccup activity. Fifteen male patients (mean [+/- SD] age, 68.2 +/- 11.6 years) who had recurring hiccup attacks for a mean duration of 100.8 +/- 134.1 months (range, 12 to 564 months) were treated for ICH with a combination of cisapride, omeprazole, and baclofen (COB). Therapy led to a total disappearance of hiccup in 40% (6 of 15) of the treated patients. An additional 20% (3 of 15) of patients experienced substantial relief. A Mann-Whitney rank order test showed a highly significant reduction in the severity of the hiccup attacks as reflected in the subjective assessment scale scores taken before therapy (8.6 +/- 1.3) compared with those taken after 20 weeks of therapy (4.1 +/- 3.8). Thus we concluded that COB is an effective empiric therapy in at least some patients with ICH.

Adult↗
PubMed1998

GABAergic inhibition of hiccup-like reflex induced by electrical stimulation in medulla of cats.

We hypothesize that the hiccup reflex is actively inhibited through GABA(B) receptor within central connections of the hiccup reflex arc. Because the hiccup-like reflex can be elicited by electrical stimulation to a limited area within the medullary reticular formation, the hiccup-evoking site (HES), electrical stimulation (50-100 microA, three train pulses at 20 Hz) was delivered to HES by means of a metal electrode containing 1.0 mM baclofen, in anesthetized spontaneously breathing cats. The evoked response was characterized by a brief powerful increase in diaphragmatic activity and a temporal suppression of the posterior cricoarytenoid muscle, laryngeal dilator, which corresponded to the fixed motor pattern of hiccup reflex. The hiccup-like response was rapidly suppressed after microinjection of baclofen (0.1-0.5 nmol) into HES, indicating that HES has GABA(B) receptors. In the other experiments, to histologically examine the inputs to the hiccup reflex arc, unconjugated cholera toxin subunit B (UCTB) was injected into HES. Following injections of UCTB, retrogradely labelled cells were found distributed in various areas of the lower brainstem. Among these areas, the nucleus raphe magnus (RM) is reported to have GABA-containing cells. It is thus hypothesized that RM is most likely to be the source of the GABAergic inhibitory inputs to the hiccup reflex arc.

Animals↗
PubMed2003

Treatment of hiccup during general anaesthesia or sedation: a qualitative systematic review.

BACKGROUND AND OBJECTIVE: Acute hiccup is a minor complication that can occur during sedation or general anaesthesia. The disorder can disturb the surgical field, might interfere with lung ventilation or could hamper diagnostic procedures. The objective was to perform a systematic search for interventions aimed at treating hiccup occurring during anaesthesia or sedation. METHODS: A systematic search for reports describing interventions to treat hiccup in conjunction with anaesthesia was carried out (MEDLINE, EMBASE, Cochrane-Library, manual screening of reference lists and review articles, up to December 2001). Search terms were 'hiccup', 'singultus' or 'hiccough'. RESULTS: Twenty-six reports involving approximately 581 patients focused on hiccup remedies in the anaesthesia setting. Only one report was substantiated by a randomized controlled trial. This investigated methylphenidate 10 mg intravenously in 51 patients, which did not show a beneficial effect compared with placebo. Hiccup was a self-limiting phenomenon. Case series and case reports focused on various systemically applied drugs in 12 reports, stimulating techniques (e.g. pharyngeal stimulation) in seven, topical applied remedies (e.g. intranasal ice-cold water) in four, and ventilation techniques (e.g. continuous positive pressure ventilation) in two. CONCLUSIONS: A large variety of interventions have been proposed for the treatment of hiccup during anaesthesia and sedation. However, perioperative treatment is still based on empirical findings and no treatment is 'evidence-based'. Thus, no valid recommendations for the treatment of hiccup can be derived. Uncontrolled observations are inadequate to establish treatment efficacy.

Anesthesia, General↗