A hiccup is an involuntary spasmodic contraction of the muscle at the base of the lungs (diaphragm) followed by the rapid closure of the vocal cords. Usually, hiccups last for a few hours or, occasionally, a day or two. However, chronic hiccups are ones that continue for an extended period of time.
It can be caused by conditions such as gastroesophageal reflux, liver disease, kidney disease and esophageal inflammation . Sometimes there is no discernable cause.
The basic workup includes a CBC, sedimentation rate, chemistry panel, a VDRL test, tuberculin test, EKG, chest x-ray, and a flat plate of the abdomen. If these are negative, an upper GI series and esophagogram should be done. If there is still confusion at this point, a gastroenterologist should be consulted before ordering other expensive diagnostic tests. The gastroenterologist will probably do an esophagoscopy, gastroscopy, and duodenoscopy and may order a CT scan of the abdomen and mediastinum. A Bernstein test may help diagnose reflux esophagitis. Esophageal manometry and pH monitoring of the distal esophagus may also help in this regard.
If abdominal distention is the probable cause of hiccups, teach the patient lifestyle changes, such as eating smaller, more frequent meals and avoiding large meals before bedtime. Also, advise the patient to increase fiber and fluid intake to avoid constipation. Warn the patient with chronic renal failure that persistent hiccups, usually accompanied by nausea and vomiting, can indicate worsening or acute decompensation of renal function.