IDIOPATHIC CHRONIC HICCUP - COMBINATION THERAPY WITH CISAPRIDE, OMEPRAZOLE, AND BACLOFEN

Idiopathic chronic hiccup (ICH) is defined as recurring hiccup attacks that last for longer than an arbitrary time limit leg, 1 month) and f or which no organic cause can be found. In patients with ICH, therapy is largely empiric. For practical purposes, idiopathic hiccup can be a ssumed to have its origin either in the viscera (gastrointestinal trac t) or in the central nervous system. Cisapride and omeprazole-through reduction of gastric acid production and facilitation of gastric empty ing, respectively-are thought to reduce an assumed afferent input from the periphery to a putative supraspinal hiccup center. Baclofen is th ought to reduce excitability and depress reflex hiccup activity. Fifte en male patients (mean [+/- SD] age, 68.2 +/- 11.6 years) who had recu rring hiccup attacks for a mean duration of 100.8 +/- 134.1 months (ra nge, 12 to 564 months) were treated for ICH with a combination of cisa pride, omeprazole, and baclofen (COB). Therapy led to a total disappea rance of hiccup in 40% (6 of 15) of the treated patients. An additiona l 20% (3 of 15) of patients experienced substantial relief. A Mann-Whi tney rank order test showed a highly significant reduction in the seve rity of the hiccup attacks as reflected in the subjective assessment s cale scores taken before therapy (8.6 +/- 1.3) compared with those tak en after 20 weeks of therapy (4.1 +/- 3.8). Thus we concluded that COB is an effective empiric therapy in at least some patients with ICH.