What is the usual reason for hiccups?

Usual Reason for Hiccups

The most common cause of hiccups is gastric distension, followed by gastroesophageal reflux disease (GERD) and gastritis. 1, 2, 3

Pathophysiology

Hiccups result from involuntary contractions of the diaphragm and auxiliary respiratory muscles, followed by sudden glottic closure that produces the characteristic "hic" sound. 4 This phenomenon is controlled by a complex reflex arc involving:

• Peripheral receptors (primarily in the gastrointestinal tract) 1
• The phrenic and vagus nerves as afferent pathways 5
• A brainstem hiccup center that coordinates the reflex 1
• Efferent pathways back to the diaphragm and respiratory muscles 5

Any disruption along this pathway can trigger hiccups. 1

Common Causes by Duration

Acute Hiccups (< 48 hours)

Gastric overdistension is the leading identifiable cause, typically from:

• Rapid eating or drinking 3
• Carbonated beverages 2
• Aerophagia (air swallowing) 3

Alcohol intake is the second most common trigger for acute episodes. 2

These benign episodes resolve spontaneously within minutes to hours and rarely require medical intervention. 2, 3

Persistent/Chronic Hiccups (> 48 hours)

When hiccups persist beyond 48 hours, GERD becomes the predominant etiology, accounting for the majority of cases requiring medical evaluation. 1, 2

Other gastrointestinal causes include:

• Gastric and duodenal ulcers 2
• Gastritis 2, 3
• Esophagitis 2

Clinical Significance

Short hiccup bouts are physiologic and benign, occurring even in fetuses and requiring no medical attention. 2, 4 The purpose of this reflex remains unknown despite its universal occurrence. 2

Persistent hiccups warrant investigation as they may indicate underlying pathology including myocardial infarction, brain tumors, renal failure, or abdominal surgery complications. 2 However, upper gastrointestinal pathology remains the most frequent culprit. 2

Important Clinical Context

One notable mention in the guidelines describes hiccups as a symptom of phrenic nerve compression from pericardial effusion, where local compression can cause hiccups alongside dysphagia and hoarseness. 6 However, this represents an uncommon cause compared to the predominant gastrointestinal etiologies. 1, 2