Differential Diagnosis for a 25-year-old Male with a 1-month History of Hiccups

• Single most likely diagnosis:
  • Gastroesophageal reflux disease (GERD) - This is a common condition that can cause irritation of the nerves that control breathing, leading to hiccups. The chronic nature of the hiccups (1 month) suggests an underlying condition like GERD.
• Other Likely diagnoses:
  • Gastritis - Inflammation of the stomach lining can irritate the nerves and cause hiccups.
  • Laryngitis - Inflammation of the larynx can affect the nerves controlling the diaphragm, leading to hiccups.
  • Pneumonia or other respiratory infections - Irritation of the lungs or diaphragm can cause hiccups.
  • Stress or anxiety - Psychological factors can contribute to hiccup episodes.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Cardiac conditions (e.g., myocardial infarction, pericarditis) - Although less common, cardiac issues can cause hiccups due to irritation of the phrenic nerve.
  • Neurological conditions (e.g., stroke, multiple sclerosis, meningitis) - Certain neurological disorders can affect the brain's breathing centers, leading to hiccups.
  • Cancer (e.g., lung, pancreatic, or stomach cancer) - Tumors can press on nerves, causing hiccup episodes.
• Rare diagnoses:
  • Inflammatory conditions (e.g., sarcoidosis, tuberculosis) - These conditions can cause widespread inflammation, potentially affecting nerves and leading to hiccups.
  • Electrolyte imbalances (e.g., hyponatremia, hypokalemia) - Severe imbalances can affect nerve function, leading to hiccup episodes.
  • Medication side effects - Certain medications can cause hiccups as a side effect, though this is less common.