Hiccups with a Twist: A Rare and Surprising Cause Behind Those Involuntary Spasms

Hiccups is a reflex consisting of a sudden spasmodic contraction of the diaphragm causing shaking of the inspiratory muscles of the chest and abdomen, followed by the sudden closure of the glottis.¹ Persistent hiccups, i.e., lasting longer than 48 hours, usually signify an underlying organic cause and must be evaluated. Gastroesophageal disorders such as aerophagia, peptic ulcer disease, esophagitis, gastritis, and pancreatitis are the common causes of persistent hiccups. Distal esophageal spasm (DES) usually presents with dysphagia and chest pain.² There have been no case reports of DES presenting with hiccups as a primary complaint. Our patient presented with persistent hiccups as a primary complaint and was initially treated as gastroesophageal reflux disease-related hiccups. On further investigations, he was found to have DES, which completely resolved after peroral endoscopic myotomy procedure.