[Singultus - Diagnostic Workup and Therapy]

Area of Science:

• Neurology
• Gastroenterology
• Internal Medicine

Background:

• Hiccups are a reflex with debated functional relevance, usually minor but can severely impact quality of life.
• Chronic hiccups (>48 hours) frequently link to gastroesophageal reflux or can signal serious neurological disorders.
• Underlying causes span multiple organ systems, including central nervous system diseases like NMO and stroke.

Purpose of the Study:

• To review the diagnostic and therapeutic challenges of chronic hiccups.
• To highlight the need for an interdisciplinary approach in managing persistent hiccups.
• To discuss current treatment strategies and the need for further research.

Main Methods:

• Literature review of causes, diagnosis, and management of chronic hiccups.
• Analysis of neuroimaging findings in patients with chronic hiccups.
• Summary of pharmacological and interventional treatment options.

Main Results:

• Gastroesophageal reflux is a common cause, while neurological conditions like NMO and Wallenberg syndrome are significant underlying diseases.
• Neuroimaging often reveals lesions in the medulla oblongata.
• Current treatment lacks optimal evidence-based recommendations, with therapies including PPIs, prokinetics, baclofen, gabapentin, anticonvulsants, and nerve blocks.

Conclusions:

• Chronic hiccups present a diagnostic and therapeutic challenge requiring an interdisciplinary approach.
• Effective management strategies are limited, necessitating further research for evidence-based guidelines.
• Persistent hiccups, especially in palliative care, demand specialized attention and treatment options.