Hiccups can lead to significant adverse outcomes including malnutrition, 
weight loss, fatigue, dehydration, insomnia, mental stress, and 
decreased quality of life [1,5].




Central nervous system disorders — vascular, infectious and structural 
processes

Vagus and phrenic nerve irritation — Irritation of the vagus and phrenic 
nerve are common causes of persistent or intractable hiccups [14,15]. 
Causes of nerve irritation include:
●Pharyngitis, laryngitis, or tumors of the neck that stimulate the 
recurrent laryngeal nerve (a branch of the vagus nerve).
●Goiters, tumors, or cysts in the neck, mediastinal masses, and 
abnormalities of the diaphragm that irritate the phrenic nerve.
●Foreign bodies in contact with the tympanic membrane that irritate the 
auricular branch of the vagus.

Gastrointestinal disorders — Gastrointestinal disorders include gastric 
distention, gastritis, gastroesophageal reflux, diaphragmatic 
eventration (protrusion), peptic ulcer disease, pancreatitis, pancreatic 
cancer, gastric carcinoma, abdominal abscesses, gallbladder disease, 
inflammatory bowel disease, hepatitis, aerophagia, esophageal 
distention, and esophagitis [16].

AIDS, particularly when associated with esophageal diseases such as 
esophageal candidiasis

Thoracic disorders —
enlarged lymph nodes secondary to infection or neoplasm, pneumonia, 
empyema, bronchitis, asthma, pleuritis, aortic aneurysm, mediastinitis, 
mediastinal tumors, and chest trauma


Cardiac disorders — hiccups are myocardial infarction and pericarditis
uremia and hyponatremia
Postoperative — general anesthesia, intubation (with glottic 
stimulation), and visceral irritation
Drug-related — medications that lead to hiccups include diazepam, 
barbiturates, dexamethasone, certain chemotherapeutic agents, and alpha 
methyldopa
Psychogenic factors — anxiety, stress, excitement, and malingering

AO/
algemeen lab, amylase en lipase
medicatie
gastro
evt. ECG
evt. i.c.c. neurologie
evt. CT hals t/m abdomen

persistence of hiccups during sleep suggests an organic rather than 
psychogenic etiology.

In the physical examination, the external auditory canals should be 
examined to rule out potential irritants of tympanic membranes such as 
an infection or a foreign body. A detailed head and neck examination is 
important to exclude an enlarged thyroid and lymphadenopathy

Other studies to consider in the appropriate clinical settings include 
[28-30]:
●Magnetic resonance imaging of the head in patients with neurologic 
symptoms or worsening headaches
●Lumbar puncture in patients with possible infection of the central 
nervous system (eg, meningitis) or possible malignancy
●Bronchoscopy in patients with pulmonary symptoms or lesions seen on imaging
●Esophageal manometry in patients with dysphagia not explained by endoscopy
●Pulmonary function tests with shortness of breath or wheezing otherwise 
not explained

advanced cancer, the cause of intractable hiccups is often 
multifactorial, and a lengthy workup to find a cause is unlikely to 
alter management [4]. Therefore, the focus in these patients should be 
treating symptoms rather than an extensive evaluation.

maagzuurremming
maneuvers
medicatie
phrenic nerve crushing or blocking with a local anesthetic