hiccup

Classification according to ICD-10
R06.6	Singultus
ICD-10 online (WHO version 2019)

The hiccups ( Latin singultus , sobbing, rattling) is a powerful, reflexive and periodic inhalation movement ( contraction ) of the diaphragm , with every inspiration being interrupted by sudden vocal cord closure. This produces a characteristic intake of breath that umgangssprachlich- onomatopoeic is verbalized as a "Hick (s)" and, accordingly, also referred to as "Hicker", "Hickser" or "Hetscher". The purpose of the hiccups and the underlying pathophysiological mechanisms are poorly understood.

Audio sample of a human hiccup

causes

Hiccups can be both harmless and pathological in humans.

• Most of the time, the hiccups are caused by temporary overstretching of the stomach, such as when eating quickly, by carbonated and cold drinks or by spicy food .
• Vegetative changes such as alcohol consumption or states of excitement can trigger it.

Such forms only last for a short time and disappear on their own.

A chronic persistent hiccups may rarely be an expression of another underlying disease, as:

• Disorders of the diaphragm, e.g. B. in gastroesophageal reflux disease , inflammation, an abscess lying under the diaphragm, a gastric ulcer , as well as irritation from operations in the upper abdomen.
• Disturbances in the course of the phrenic nerve , which innervates the diaphragm
• Disturbances in the central nervous system

Often no cause can be found ( idiopathic singultus ).

Consequences of chronic hiccups

In particularly rare cases, people suffer from chronic hiccups for many years. The longest uninterrupted hiccups in humans allegedly lasted from 1922 to 1990. Such a condition not only brings physical limitations with it, but also often affects the psyche and can lead to suicide . On the physical level, constant hiccups impair the oxygen supply and lead to sleep disorders . At the University of Heidelberg there is a therapy center for patients with chronic hiccups.

therapy

There are many home remedies for hiccups that are primarily aimed at calming the breathing and the diaphragm. For example, holding your breath for 30 seconds is said to help in some cases. A few people can even relax their diaphragm by focusing on their breathing, thereby ending the hiccups. Many home remedies also have something to do with paying attention (distraction, frightening) or making swallowing difficult on purpose, such as swallowing dry / holding your breath, swallowing against the stomach muscles, or swallowing upside down.

The medical literature also mentions some other forms of treatment, in addition to pharmacological ones such as cannabis also orgasms , rectal massages with the fingers or the nasal application of vinegar. Vomiting should also stop the hiccups. From the Japanese Kappo , a traditional healing method, another measure has been handed down, in which one exerts pressure on a certain area of ​​the neck.

Medicines are treated with proton pump inhibitors , prokinetics , sympathomimetics , sedatives and neuroleptics; formerly with triflupromazine (was taken off the market in 2003) or diazepam , today often with the antispasmodic baclofen .

Traditional attempts at explanation

As with sneezing (sternution, sternutation), all sorts of traditional, superstitious ideas are (or were) associated with hiccups , such as that a person who is not present is thinking of the person who is hiccuping at that moment.

Other explanations

Breathing is essentially controlled by the brain stem between the cerebrum and the spinal cord. In fish, it regulates the rhythmic muscle movements in the nearby throat and gills . In mammals, the muscles of the chest wall and diaphragm are controlled by the brain stem. Long ducts have developed for this purpose: the vagus and phrenic nerves . The complicated course causes the susceptibility of this construction to failure. Anything that interferes with the function of one of these nerves can trigger uncontrolled contractions.

The pattern generator responsible for the hiccups in the brainstem is also found in tadpoles and lungfish ; both animals breathe through their lungs and gills. This generator is active when breathing is through the gills. The water is directed through the mouth, throat and gills, but must not get into the lungs. This is prevented by the glottis (epiglottis = larynx cover), a tissue cover that then covers the windpipe. Closing the glottis when breathing with water is a modified form of hiccups.

Fetuses already have hiccups . It is believed that it trains the respiratory reflex or pushes amniotic fluid out of the esophagus. After birth, the hicksen is considered a relic from the womb.

Hiccups also occur after gastric contents reflux into the esophagus or when swallowing too little saliva and too dry food. This diaphragmatic reflex then acts on the esophagus at the level of the diaphragm-esophageal slot as a means of clearing the "blocked" esophagus. Subsequent drinking of fluids can also clear the esophagus of its contents and thus relieve the hiccups. Another way to reduce hiccups is to breathe back into a plastic bag (used to relieve respiratory depression ) .

Otherwise, hiccups can occur when eating food and drinks that are too hot or too cold or with a number of illnesses and also with psychological excitement or irritation of the central nervous system due to changed chemical composition of the blood.

Designations

In Austria and Bavaria, hiccups are called "Schnackerln" (plural or infinitive of "Schnackerl") or "Schnackler" (also "Schnackerlstossen") ("He has a Schnackler" or "He has Schnackerl").

In Switzerland he is called "Gluggsi" ( Basel region ) or "Hitzgi" ( Zurich region ) ("Er hät de Hitzgi").

In Swabia (Württemberg) and in Baden the hiccups are called "Gluckser, Gluggser" or "Häcker, Hickser" ("He has the Gluckser / Gluggser / Häcker"), in Franconia as "Hädscher", in Schleswig-Holstein as " Hickop ”and in the Palatinate as“ Schluggser ”/“ Schluckser ”. In the Ruhr area the version "Hickeschlick" and in the Lower Rhine "Hickepick" are common. Hiccups are also referred to as "swallowing". In the Swabian Allgäu, the hiccups are called "Hesch" or "Häsch". In the Rhine area they say “Schlicks”, in Westphalian “Hicks”. In Hessian “Schligges” or “Schlickes” is a common term.

Representations in cultural works

In Roberto Bolaño's Monsieur Pain (1999), César Vallejo dies of constant hiccups. In Jonathan Lethem's Chronic City (2009), the hiccups carried over from a pit bull to a human. Its internal organs are fatally damaged by the spasms caused by the permanent hiccups . Monologues with hiccups are called "hickologs" here. In Kurt Vonnegut's Timequake (1997) a u. a. Disturbance of the space-time continuum called "hiccups" so that the years 1991 to 2001 repeat themselves unchanged.

In the Hungarian film Hukkle - Das Dorf (2002) the ( onomatopoeic ) eponymous hiccups are used as a structuring stylistic feature.

literature

• Launois et al .: Hiccup in adults: an overview . In: European Respiratory Journal , 1993, pp. 563-575, abstract
• C. Straus et al .: A phylogenetic hypothesis for the origin of hiccough . In: BioEssays . 25, No. 2, 2003, pp. 182-188. doi : 10.1002 / bies.10224 .

Web links

Wiktionary: Hiccups  - explanations of meanings, word origins, synonyms, translations

• Ruprecht-Karls-Universität Heidelberg: Medical advice center for patients with chronic hiccups
• 9 household tips to stop the hiccups

Individual evidence

1. ↑ ^{a b} Neil Shubin: The Fish in Us . S. Fischer Verlag, Frankfurt am Main 2008, ISBN 978-3-10-072004-7
2. ^ University of Heidelberg : Therapy Center Chronic Singultus . Retrieved May 31, 2017.
3. ^ I Gilson et al .: Marijuana for intractable hiccups . In: The Lancet , 1998 Jan 24, 351 (9098), p. 267
4. ^ R. Peleg et al .: Case report: sexual intercourse as potential treatment for intractable hiccups . In: Can Fam Physician , 2000 Aug, 46, pp. 1631–1632, PMC 2144777 (free full text)
5. ↑ LM Fesmire: Termination of intractable hiccups with digital rectal massage . In Annals of Emergency Medicine , 1988 Aug, 17 (8), p. 872
6. ↑ M. Odeh et al .: Termination of intractable hiccups with digital rectal massage . In: Journal of Internal Medicine , 1990 Feb, 227 (2), pp. 145-146, PMID 2299306 .
7. ^ N. Iwasaki et al .: Hiccup treated by administration of intranasal vinegar . In: No To Hattatsu , 2007 May, 39 (3), pp. 202-205, PMID 17515134 .
8. ↑ Florian G. Mildenberger on: Robert R. Provine : Curious behavior: yawning, laughing, hiccupping, and beyond . The Belknap Press, Cambridge (Mass.) 2012, ISBN 978-0-674-04851-5 . In: Specialized prose research - Crossing borders. Volume 8/9, 2012/2013 (2014), p. 588 f., Here: p. 589.
9. ↑ The Kuatsu Network . Retrieved May 30, 2012.
10. ↑ Hiccups. In: Karl Spangenberg et al .: Thuringian dictionary . Akademie-Verlag, Berlin 1966.
11. ↑ C. Straus et al .: A phylogenetic hypothesis for the origin of hiccough . In: BioEssays . 25, No. 2, 2003, pp. 182-188. doi : 10.1002 / bies.10224 .
12. ↑ FOCUS health: stomach & intestines. FOCUS Magazin Verlag, 2014, p. 59 ( limited preview in Google book search).
13. ^ Walter Siegenthaler: Siegenthaler's differential diagnosis. Georg Thieme Verlag, 2005, ISBN 978-3-133-44819-2 , p. 49 ( limited preview in the Google book search).
14. ↑ P. Gerhardt Scheurlen: Differential Diagnosis in Internal Medicine. Springer-Verlag, 2013, ISBN 978-3-642-73507-3 , p. 332 ( limited preview in Google book search).
15. ↑ K. Amersbach: Breathing. Springer-Verlag, 2013, ISBN 978-3-662-21650-7 , p. 358 ( limited preview in the Google book search).
16. ↑ Austrian dictionary . 35th edition 1979. “das Schnackerl, -s, der Schnackerl: short (repeated) cramp-like diaphragmatic movement; the noise "
17. ↑ Jonathan Lethem: Chronic City . Tropen Verlag, Hamburg 2011, p. 446.
18. ↑ Kurt Vonnegut : Time Quake . Goldmann Verlag, Munich 2000, p. 106.

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