gastrointestinal disorders
Hiccups
Evaluation of Hiccups
History of present illnessshould note duration of hiccups, remedies tried, and relationship of onset to recent illness or surgery. Review of systemsseeks concomitant gastrointestinal (GI) symptoms such as gastroesophageal reflux and swallowing difficulties; thoracic symptoms such as cough, fever, or chest pain; and any neurologic symptoms. Past medical historyshould query known GI and neurologic disorders. A drug history should include details concerning alcohol use. Examination is usually unrewarding but should seek signs of chronic disease (eg, cachexia). A full neurologic examination is important. The following is of particular concern: Neurologic symptoms or signs Few findings are specific. Hiccups after alcohol consumption or surgery may well be related to those events. Other possible causes ( see Table: Some Causes of Intractable Hiccups ) are both numerous and rarely a cause of hiccups. No specific evaluation is required for acute hiccups if routine history and physical examination are unremarkable; abnormalities are pursued with appropriate testing. Patients with hiccups of longer duration and no obvious cause should have testing, probably including serum electrolytes, bloodureanitrogen (BUN) and creatinine, chest x-ray, and ECG. Upper GI endoscopy and perhaps esophageal pH monitoring should be considered. If these are unremarkable, brain MRI and chest CT may be done. 