Authors
Mickael Aubignat
Published in
La Revue de medecine interne. Oct 09, 2026. Epub Oct 09, 2026.
Abstract
Chronic hiccups, defined as lasting more than 48hours, represent an underestimated clinical entity with potentially severe impacts on patients' quality of life. The pathophysiology involves a reflex arc comprising the phrenic and vagus nerves, integrated at the pontomedullary level. Recent advances highlight the role of a central pattern generator and neurotransmitter systems (GABA, dopamine, serotonin) in the genesis and perpetuation of hiccups. Epidemiological data reveal a striking male predominance (82-92% of cases), with an organic cause identified in over 90% of men. Etiologies are dominated by gastrointestinal causes, particularly gastroesophageal reflux disease (up to 80% of cases), followed by central neurological causes including Wallenberg syndrome. The diagnostic approach relies on targeted history and physical examination, complemented by laboratory tests, chest radiography, upper gastrointestinal endoscopy, and brain imaging when clinically indicated. Therapeutic management follows a stepwise approach: etiological treatment, proton pump inhibitors as first-line therapy, followed by baclofen or gabapentin. Refractory cases may require neuroleptics or interventional techniques (phrenic nerve block, acupuncture). Despite the absence of formal guidelines, this review proposes a pragmatic diagnostic and therapeutic algorithm based on current literature evidence.
PMID:
42855361
Bibliographic data and abstract were imported from PubMed on 10 Oct 2026.
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