Abstract

Hiccup is a characteristic noise caused by a sudden closure of the glottis following repeated, involuntary, spasmodic contraction of the diaphragm and the auxiliary respiratory muscles. It is usually a physiological entity when it is transitory and of short duration; however, it may become a pathological sign when its duration exceeds a certain length of time and it is unresponsive to simple measures. This situation is defined as intractable hiccup and may be associated with serious complications unless it is properly dealt with. Persistent hiccups are usually evoked by diseases of the gastrointestinal , thoracicmediastinal and central nervous systems, toxicmetabolic conditions, and the use of certain drugs. In addition to symptomatic treatment, a systematic evaluation is required to uncover the underlying cause. This article reviews the mechanisms, causes, evaluation, and treatment of intractable hiccups.