BACLOFEN THERAPY FOR CHRONIC HICCUP

Chronic hiccup is a rare but potentially severe condition, that can be symptomatic of a variety of diseases, or idiopathic. Many therapeutic interventions have been reported, most often as case reports. Among o ther drugs, baclofen has been suggested as a therapy for chronic hiccu p. In a large series of patients, we have evaluated its therapeutic po sition. In patients with chronic hiccup, defined as hiccup spell or re curring hiccup attacks lasting more than 7 days, investigation of the upper gastro-oesophageal tract (fibroscopy, manometry, and pH monitori ng) was systematically performed. Most patients had tried numerous dru gs in the past, without success. Baclofen was used as a first treatmen t in patients without evidence of any gastro-oesophageal disease (n=17 ), and was undertaken only after full treatment of such disease (n=55) had France failed to solve the hiccup problem (n=20). Baclofen has, t herefore, been administered to 37 patients with chronic hiccup (averag e duration 4.6 yrs). Baclofen produced a long-term complete resolution (18 cases) or a considerable decrease (10 cases) of hiccups in 28 of the 37 patients. There was no significant difference between patients with or without gastro-oesophageal disease. We conclude that so-called idiopathic chronic hiccup often results from gastrooesophageal abnorm alities. Also, if controlled studies confirm our encouraging results, baclofen can be a major element in the treatment of chronic hiccup tha t is idiopathic, or that cannot be helped by treatment of gastrooesoph ageal diseases.