Hiccup

Hiccup is defined as involuntary contractions of the diaphragm and the auxi liary respiratory muscles, mostly in irregular series, followed by glottic closure, thereby producing a typical "hiccuping" inspiration. This is a phy siologic phenomenon, which already exists in utero. Hiccup is believed to b e a gastrointestinal reflex; however, function and the reflex arch are hypo thetical. Acute hiccup is distinguished from pathological, chronic hiccup, defined by a duration execuiding 48 h, or recurrent episodes. Among approxi mately 100 causes for hiccup, the most common are located in the gastrointe stinal tract, with gastro-esophageal reflux as the most important. While th e respiratory effect is generally negligible,alkalosis may ensue in tracheo tomized patients due to hyperventilation. A stepwise management plan for pa tients with hiccup is presented. If simple physical maneuvers and causal th erapy fail, or causal therapy is impossible, the treatment of choice is med ical, with baclofen. Interruption of the reflex arch may be causal therapy or be considered as a last resort.