Hiccups

Hiccups

1. HICCUPS Ade Wijaya , MD November 2017

2. Outline: Introduction Classification Epidemiology Pathophysiology Etiology Investigation Treatment Pharmacological Non-pharmacological Summary

3. Introduction Bailey, 1943 Involuntary repetitive myoclonic contraction of diaphragm Singultus Rapid intake of air, interupted by glottis closure 4-60 per minute Kahrilas PJ, Shi G. Why do we hiccup? Gut 1997 Chang FY, Lu CL. Hiccup: mystery, nature and treatment. J Neurogastroenterol Motil 2012; 18:123–30 Friedman NL. Hiccups: a treatment review. Pharmacotherapy 1996;16: 986–95

4. Classification Kolodzik PW, Eilers MA. Hiccups ( singultus ): review and approach to Systematic review: treatment of hiccups management. Annal Emerg Med1991; 20: 565 –73 .

5. Epidemiology 55 per 100.000 patients CNS vs GI tract diseases 20 %  PD 10 %  reflux diseases 3,9-4,8 %  advanced cancer - Cymet TC. Retrospective analysis of hiccups in patients at a community hospital from 1995-2000. J Natl Med Assoc 2002; 94: 480–3 . - Rey E, Elola-Olaso CM, Rodriguez- Artalejo F , Locke GR 3rd, Diaz-Rubio M. Prevalence of atypical symptoms and their association with typical symptoms of gastroesophageal reflux in Spain.Eur J Gastroenterol Hepatol 2006;18: 969–75 . - Khorakiwala T, Arain R, Mulsow J, Walsh TN. Hiccups: an unrecognized symptom of esophageal cancer? Am J Gastroenterol 2008;103: 801. - Porzio G, Aielli F, Verna L, Aloisi P, Galletti B, Ficorella C. Gabapentin in the treatment of hiccups in patients with advanced cancer: a 5-year experience. Clin Neuropharmacol 2010; 33 : 179–80.

6. Pathophysiology Friedman NL. Hiccups: a treatment review. Pharmacotherapy 1996;16: 986–95

7. Etiology Carbonated drinks Chilli papers Alcohol Smoking Other irritants Over excitement Anxiety Aerophagia CNS disorders GI tract disorders Cardiovascular diseases Electrolyte imbalance Hyperglycemia Uremia Toxin or recreational drugs Benzodiazepine, steroid, opiates side effects Psychogenic Post surgery Benign More serious (usually persistent and intractable hiccups) Cabane J, Bizec JL, Derenne JP. A diseased esophagus is frequently the cause of chronic hiccup. A prospective study of 184 cases.Presse Med 2010;39:e141–6 . Greene CL, Oh DS, Worrell SG, Hagen JA . Hiccups and gastroesophageal reflux disease as seen on high resolution esophageal manometry.Dis Esophagus 2014 ; doi : 10.1111/dote.12253. Chang FY, Lu CL. Hiccup: mystery, nature and treatment. J Neurogastroenterol Motil 2012; 18:123–30

8. Steger, M., Schneemann , M., & Fox, M. (2015). Systemic review: the pathogenesis and pharmacological treatment of hiccups. Alimentary pharmacology & therapeutics , 42 (9), 1037-1050.

9. Investigation History Physical examination Laboratory Brain/chest/abdomen imaging Endoscopy 24-h pH-impedance reflux study Cabane J, Bizec JL, Derenne JP. A diseased esophagus is frequently the cause of chronic hiccup. A prospective study of 184 cases.Presse Med 2010;39:e141–6

10. Treatment ( pharmocologic ) Steger, M., Schneemann , M., & Fox, M. (2015). Systemic review: the pathogenesis and pharmacological treatment of hiccups. Alimentary pharmacology & therapeutics , 42 (9), 1037-1050.

11. Treatment (non- pharmocologic ) Steger, M., Schneemann , M., & Fox, M. (2015). Systemic review: the pathogenesis and pharmacological treatment of hiccups. Alimentary pharmacology & therapeutics , 42 (9), 1037-1050.

12. Steger, M., Schneemann , M., & Fox, M. (2015). Systemic review: the pathogenesis and pharmacological treatment of hiccups. Alimentary pharmacology & therapeutics , 42 (9), 1037-1050.

13. Summary Acute vs persistent vs intractable Various causes, usually benign Persistent & intractable hiccups usually caused by more serious pathology such as CNS, GI tracts, or cardiovascular disorders Treatment: pharmocological vs non-pharmacological 1 st line pharmacological treatment: baclofen & gabapentin