9th January 2024

Hiccups

Bouts of hiccups (lasting less than 48 hours) are common, but palliative patients may experience persistent (lasting 48 hours to 1 month) or intractable (lasting over 1 month) hiccups. Persistent or intractable hiccups are estimated to affect up to 9% of palliative patients and can have a detrimental effect on sleep, eating, drinking and mood.

The most common cause is gastric stasis and distension, but other causes include:

• Reflux
• Diaphragmatic/ phrenic nerve irritation
• Metabolic disturbance, e.g., uraemia
• Infection
• Hepatomegaly

Management

• Most evidence is based on case-control studies, and there are currently no RCTs for hiccups
•  Non-Pharmacological:
  • Simple measures like holding breath, sipping iced water or pulling knees up to the chest
• Pharmacological:
  • Anti-flatulent peppermint water 10ml BD
  • Prokinetics metoclopramide or domperidone TDS – Not to be used with peppermint water due to opposing effects on gastro-oesophageal sphincter
  • PPI if reflux
  • Muscle relaxants, e.g., baclofen or midazolam, may be initiated by specialists
  • Dexamethasone 4-8mg OD can reduce compression/ irritation if hepatic, mediastinal or cerebral disease