Causes of Chronic Hiccups (for two days or more).

Hiccups lasting for two days or more are no longer being. Instead, they often reflect disease in the stomach, brain, ear, or others.

Usually, hiccups last for brief periods (often minutes). However, less common variants of hiccups may last for days, months, or even years.

The medical definition of chronic hiccups is any hiccups that last for two days or more. Chronic hiccups are further subdivided into:

• Persistent hiccups: any hiccups that last between two days to one month.
• Intractable hiccups: hiccups that last more than one month.

As a rule, the causes of acute hiccups (lasting less than two days) are often benign. They include:

• Stomach distension (Overeating or over-drinking): that is why many people get constant hiccups after eating.
• Carbonated drinks: the released gas inside your stomach leads to severe distension, which triggers hiccups.
• Drinking alocholi.
• Eating Too quickly (leads to swallowing of air and stomach distension).
• Sudden temperature changes.
• Swallowing too much air.

On the other hand, Hiccups for two days or more may reflect a disease affecting the hiccups reflex.

Common causes of chronic hiccups include:

1. Diseases affecting your digestive system.

We don’t know the exact purpose of hiccups. But many believe it is due to digestive system irritation or distension. Chronic diseases of the digestive system can cause hiccups that last for two days or more.

Common digestive diseases leading to chronic hiccups include:

– Chronic gastritis and peptic ulcer disease.
– GERD and esophagitis.
– Stomach or esophageal cancer.
– Pancreatitis and pancreatic cancer.
– Gallbladder diseases (as gallstone disease).
– Inflammatory bowel disease, Bowel obstruction.

2. Diseases of the central nervous system.

The hiccups reflex is regulated by the brain centers and the nerves origination from the spinal cord. Major brain diseases can cause persistent hiccups for two days or more.

Common neurological diseases involved in hiccups include:

– Cerebral stroke.
– Severe head trauma.
– Brain tumors.
– Multiple sclerosis.
– Infections (brain abscess, meningitis, encephalitis).
– Malformation of brain blood vessels.
– Inflammations of the vessel wall (as temporal arteritis)

3. Toxins and toxic metabolites.

Accumulation of toxins, whether external toxins (alcohol) or toxins resulting from metabolic diseases, can irritate the vagus and phrenic nerves. Vagus and phrenic nerves are responsible for the hiccups reflex.

Common causes include:

– Alcohol abuse.
– Diabetes Mellitus.
– Renal failure.
– Hypocalcemia, Hyponatremia (↓ sodium).

4. Chest diseases.

Common causes:

– Pneumonia (lung infection), bronchitis.
– Enlarged lymph nodes around the esophagus (mediastinal LNs).
– Bronchial asthma.
– Inflammation of the lung envelope (pleurisy) or pus (empyema).
– Tumors and trauma of the mediastinum.

5. Vagus and phrenic nerve irritation.

The vagus and phrenic nerves are the two primary nerves involved in hiccups. The vagus nerve supplies the stomach and the digestive system. The phrenic nerves supply the diaphragm (which contracts during hiccups).

Any chronic irritation to these nerves will lead to chronic hiccups (for two days or more).

Causes include:

– Pharyngitis and laryngitis.
– FB or hair inside the air (irritation of eardrum).
– Enlarged thyroid gland (goiter).
– Neck cysts or neck tumors.

6. Drugs that cause chronic hiccups.

– Chemotherapy (as carboplatin).
– Corticosteroids(as dexamethasone).
– Some anti-hypertensives such as Alphamethyldopa.
– Sedativesosuch as Barbituratesoandodiazipam.

7. Psychological hiccups.

People with intensive stress or psychological diseases may experience prolonged hiccups for two or more days.

Causes:

– Anorexia Nervosa.
– Post-traumatic stress disorder.
– Extreme excitement, stress.
– Schizophrenia, conversion reactions.
– Malingering.

8. Hiccups after surgery.

Hiccups can be prolonged for two or more days after surgery. The two main mechanisms of hiccups after surgery are:

– General Anaesthesia (anesthetic medications affect digestive system motility).
– Insertion of the endotracheal tube (during general anesthesia).

9. Others.

– Myocardial infarction.
– Inflammation of the membrane surrounding your heart (pericarditis).
– Access under the diaphragm (subphrenic abscess).
– Malaria, TB, Herpes Zoster, and Covid-19 (reference).

When to see a doctor for hiccups:

Simple attacks of hiccups lasting for minutes (often after eating) are considered benign. Also, they are frequent in newborns and young infants. No need to see a doctor unless:

• Hiccups become very frequent (come and go for several days)
• Constant hiccups for more than two days.
• Hiccups that interfere with your sleeping.
• Hiccups constantly interfere with your eating or breathing.
• Having signs and symptoms of diseases that can cause hiccups, such as heartburn (acid reflux).