Hiccup
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ICD-10 | R06.6 |
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ICD-9 | 786.8 |
A hiccup or hiccough (normally pronounced "HICK-up" (IPA: [ˈhɪ.kəp]) regardless of spelling) is an involuntary spasm of the diaphragm; typically this repeats several times a minute. The sudden rush of air into the lungs causes the glottis to close, creating the "hic" listen noise. A bout of hiccups generally resolves itself without intervention, although many home remedies are in circulation that claim to shorten the duration, and medication is occasionally necessary. By extension, the term "hiccup" is also used to describe a small and unrepeated aberration in an otherwise consistent pattern. The medical term is singultus.
While many cases develop spontaneously, hiccups are known to develop often in specific situations, such as eating too quickly, taking a cold drink while eating a hot meal, eating very hot or spicy food, laughing vigorously or coughing, drinking an alcoholic beverage to excess, or electrolyte imbalance. Hiccups may be caused by pressure to the phrenic nerve by other anatomical structures, or rarely by tumors and certain kidney disease. It is reported that 30% of chemotherapy patients suffer singultus as a side effect of treatment. (American Cancer Society)
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[edit] Purpose
One possible beneficial effect of hiccups is to dislodge large chunks of food, which have become stuck in the esophagus, or which are traveling too slowly. When a piece of food is swallowed that is too large for the natural peristalsis of the esophagus to move quickly into the stomach, it applies pressure on the phrenic nerve, invoking the hiccup reflex. This causes the diaphragm to contract, creating a vacuum in the thoracic cavity, which creates a region of low pressure on the side of the lump of food nearest the stomach, and a region of high pressure on the side of the lump of food nearest the mouth. This pressure differential across the food creates a force, which assists peristalsis. In humans, gravity partially assists peristalsis, but in quadrupeds and many marine vertebrates, their oesophagi run roughly perpendicular to the force of gravity, so that gravity provides little assistance. The hiccup mechanism likely evolved as an aid to peristalsis in our ancestors. It only now appears to offer little benefit, as humans are upright and gravity assists peristalsis, making it very unlikely for food to become lodged in the oesophagus.
Ultrasound scans have also shown that fetuses experience hiccups. Some hypotheses suggest that hiccups are a muscle exercise for the child's respiratory system prior to birth, or that they prevent amniotic fluid from entering the lungs[1]. More research is required to ascertain their true nature, origins, and purpose, if any.
[edit] Medical treatment
Ordinary hiccups are cured easily without medical intervention; in most cases they can be stopped simply by forgetting about them. However, there are a number of anecdotally prescribed treatments for casual cases of hiccups. These include being startled, drinking water while upside down, eating something very sweet or very tart (particularly lemon juice) [2], and anything that interrupts one's breathing. Hiccups are treated medically only in severe and persistent (termed "intractable") cases. Haloperidol (Haldol, an anti-psychotic and sedative), metoclopramide (Reglan, a gastrointestinal stimulant), and chlorpromazine (Thorazine, an anti-psychotic with strong sedative effects) are used in cases of intractable hiccups. In severe or resistant cases, baclofen (an anti-spasmodic) is sometimes required to suppress hiccups. Effective treatment with sedatives often requires a dose that renders the person either unconscious or highly lethargic. Hence, medicating singultus is done short-term, as the affected individual cannot continue with normal life activities while taking the medication.
Persistent and intractable hiccups due to electrolyte imbalance (hypokalemia, hyponatremia) may benefit from drinking a carbonated beverage containing salt to balance out the potassium-sodium levels in the nervous system. The carbonation promotes quicker absorption.
Dr. Bryan R. Payne, a neurosurgeon at the Louisiana State University Health Sciences Center in New Orleans, has had some success with an experimental new procedure in which a vagus nerve stimulator is implanted in the upper chest of patients with an intractable case of hiccups. "It sends rhythmic bursts of electricity to the brain by way of the vagus nerve, which passes through the neck. The Food and Drug Administration approved the vagus nerve stimulator in 1997 as a way to control seizures in some patients with epilepsy. In 2005, the agency endorsed the use of the stimulator as a treatment of last resort for people with severe depression."[3]
In 2006, Francis Fesmire of the University of Tennessee College of Medicine received an Ig Nobel prize for medicine after he published "Termination of intractable hiccups with digital rectal massage" in 1988.[1] In an attempt to block the runaway messages on the vagus nerve, Fesmire found that stimulation of the vagus nerve by digital rectal massage worked, stopping a bout of hiccupping. Fesmire also commented "An orgasm results in incredible stimulation of the vagus nerve."[4]
[edit] Footnotes
- ^ Fesmire F. (1988). "Termination of intractable hiccups by digital rectal massage". Ann Emerg Med 17: 872.
[edit] References
- C. Straus, K. Vasilakos, RJA Wilson, et al., A phylogenetic hypothesis for the origin of hiccoughs, In: Bioessays, Vol.25, 2003, S.182-188, Abstract
- Launois et al., Hiccup in adults:an overview, In: European Respiratory Journal, 1993, S.563-575, Abstract
- Davis J. Newsom, An experimental study of hiccup, In: Brain, 1970, Vol.93, S.851-72
- J.S. Jones, T. Lloyd, L. Cannon, Persistent hiccups as an unusual manifestation of hyponatremia, In J. Emerg Med, 1987; 5:283-287
- H.J. Kaufman, Hiccups: causes, mechanisms, and treatment, In: Pract. Gastroenterology, 1985; 9:12-20
- J.H. Lewis, Hiccups: causes and cures, In: J. Clin. Gastroenterology, 1985; 7:539-552
- M.S. Lipsky, Chronic hiccups, In: Am. Fam. Physician, 1986; 34:173-177
- M.D. Nathan, R.T. Leshner, A.P. Keller, Intractable hiccups (singultus), In: Laryngoscope, 1980; 90:1612-1618
- J.V. Souadjian, J.C. Cain, Intractable hiccups: etiologic factors in 220 cases, In: Postgrad Med., 1968; 43:72-77
- M.S. Wagner, J.S. Stapczynski, Persistent hiccups, In: Ann. Emerg. Med., 1982; 11:24-26