Skip to main content
PMC home page
Gut logoLink to Gut
. 1997 Nov;41(5):590–593. doi: 10.1136/gut.41.5.590

Stimulus and site specific induction of hiccups in the oesophagus of normal subjects

R Fass 1, L Higa 1, A Kodner 1, E Mayer 1
PMCID: PMC1891586  PMID: 9414962

Abstract

Background—Hiccups that are induced by a large meal have been suggested to result from gastric overdistension. The role of the oesophagus in precipitating hiccups has never been defined. 
Aims—To determine the involvement of oesophageal mechanoreceptors in the hiccup reflex. 
Methods—Ten normal healthy subjects were prospectively evaluated at a university affiliated hospital. Controlled inflation of a polyethylene bag in the proximal and distal oesophagus was carried out using slow ramp and rapid phasic distensions, by an electronic distension device. 
Results—Hiccups were induced in four subjects only during rapid phasic distensions and only in the proximal oesophagus. The mean (SEM) minimal volume threshold for the hiccup reflex was 32.5 (4.8) ml, which was above the perception threshold. Hiccups appeared during inflation and resolved after deflation. 
Conclusions—Sudden rapid stretch of the mechanoreceptors in the proximal oesophagus can trigger the hiccup reflex in normal subjects. Only rapid distensions above a determined volume threshold will predictably induce hiccups in a given subject. This mechanism may play a role in the physiological induction of hiccups. 



Keywords: hiccups; oesophageal mechanoreceptors; electronic distension device; phasic distension; ramp distension; perception thresholds

Full Text

The Full Text of this article is available as a PDF (81.3 KB).

Figure 1 .

Figure 1

Open in a new tab

: Stimulation of hiccups by rapid, phasic distensions in the proximal oesophagus of a single subject. The black bars represent phasic distensions that induced hiccups. The hiccup volume threshold is above the perception threshold.


Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Fisher M. J., Mittal R. K. Hiccups and gastroesophageal reflux: cause and effect? Dig Dis Sci. 1989 Aug;34(8):1277–1280. doi: 10.1007/BF01537278. [DOI] [PubMed] [Google Scholar]
  2. Gluck M., Pope C. E., 2nd Chronic hiccups and gastroesophageal reflux disease: the acid perfusion test as a provocative maneuver. Ann Intern Med. 1986 Aug;105(2):219–220. doi: 10.7326/0003-4819-105-2-219. [DOI] [PubMed] [Google Scholar]
  3. Graham D. Y. Esophageal motor abnormality during hiccup. Gastroenterology. 1986 Jun;90(6):2039–2039. doi: 10.1016/0016-5085(86)90298-2. [DOI] [PubMed] [Google Scholar]
  4. Johnson D. L. Intractable hiccups: treatment by microvascular decompression of the vagus nerve. Case Report. J Neurosurg. 1993 May;78(5):813–816. doi: 10.3171/jns.1993.78.5.0813. [DOI] [PubMed] [Google Scholar]
  5. Kaufmann H. J. Hiccups: an occasional sign of esophageal obstruction. Gastroenterology. 1982 Jun;82(6):1443–1445. [PubMed] [Google Scholar]
  6. Kolodzik P. W., Eilers M. A. Hiccups (singultus): review and approach to management. Ann Emerg Med. 1991 May;20(5):565–573. doi: 10.1016/s0196-0644(05)81620-8. [DOI] [PubMed] [Google Scholar]
  7. Lewis J. H. Hiccups: causes and cures. J Clin Gastroenterol. 1985 Dec;7(6):539–552. doi: 10.1097/00004836-198512000-00021. [DOI] [PubMed] [Google Scholar]
  8. Loft L. M., Ward R. F. Hiccups. A case presentation and etiologic review. Arch Otolaryngol Head Neck Surg. 1992 Oct;118(10):1115–1119. doi: 10.1001/archotol.1992.01880100107020. [DOI] [PubMed] [Google Scholar]
  9. Marshall J. B., Landreneau R. J., Beyer K. L. Hiccups: esophageal manometric features and relationship to gastroesophageal reflux. Am J Gastroenterol. 1990 Sep;85(9):1172–1175. [PubMed] [Google Scholar]
  10. McLoughlin J. C., McGuigan J. Hiccups and oesophageal malignancy. Ulster Med J. 1991 Oct;60(2):246–247. [PMC free article] [PubMed] [Google Scholar]
  11. Odeh M., Bassan H., Oliven A. Termination of intractable hiccups with digital rectal massage. J Intern Med. 1990 Feb;227(2):145–146. doi: 10.1111/j.1365-2796.1990.tb00134.x. [DOI] [PubMed] [Google Scholar]
  12. Ramírez F. C., Graham D. Y. Treatment of intractable hiccup with baclofen: results of a double-blind randomized, controlled, cross-over study. Am J Gastroenterol. 1992 Dec;87(12):1789–1791. [PubMed] [Google Scholar]
  13. Sato S., Asakura N., Endo T., Naito H. Cervical epidural block can relieve postoperative intractable hiccups. Anesthesiology. 1993 Jun;78(6):1184–1186. doi: 10.1097/00000542-199306000-00026. [DOI] [PubMed] [Google Scholar]
  14. Seeman H., Traube M. Hiccups and achalasia. Ann Intern Med. 1991 Nov 1;115(9):711–712. doi: 10.7326/0003-4819-115-9-711. [DOI] [PubMed] [Google Scholar]
  15. Shay S. S., Myers R. L., Johnson L. F. Hiccups associated with reflux esophagitis. Gastroenterology. 1984 Jul;87(1):204–207. [PubMed] [Google Scholar]
  16. Triadafilopoulos G. Hiccups and esophageal dysfunction. Am J Gastroenterol. 1989 Feb;84(2):164–169. [PubMed] [Google Scholar]
  17. Zaninotto G., Costantini M., Ancona E. Hiccups and related esophageal motor disorders. Hepatogastroenterology. 1991 Oct;38(5):435–437. [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES