#MedicalCase
Persistent Hiccups for Five Days: Could Diaphragmatic Irritation Be the Cause? (Internal Medicine)
Dr. Kamel Omran Bin Muftah., M.B.B.CH
Medical Case Details:
Mr. Ahmed, a 62-year-old male, presented with persistent hiccups for the past five days. The hiccups were continuous and severe enough to interfere with both sleep and eating. He also reported mild epigastric discomfort and decreased appetite but denied fever, cough, vomiting, or chest pain. He has a history of hypertension for the past ten years, which is well controlled with amlodipine. He is also a chronic smoker with a history of about 20 pack-years. On examination, his vital signs were stable. There was no pallor, cyanosis, or clubbing. Chest examination was unremarkable. The abdomen was soft with mild epigastric tenderness, and neurological examination was normal. Initial laboratory investigations showed hemoglobin of 13 g/dL, total leukocyte count of 11,200/mm³, platelet count of 280,000/mm³, and mildly elevated CRP. Chest X-ray revealed a right lower lobe opacity suggestive of early pneumonia close to the diaphragm. Could diaphragmatic irritation from early pneumonia be responsible for the persistent hiccups in this patient? What would be the recommended approach for further evaluation and management in such cases?Discussions
Dr. Tkhir Ihor Ihorovych
General Practitioner
First of all, it is important to note the almost complete absence of clinical features of pneumonia (no cough, fever, dyspnea, or pleuritic chest pain), with only a radiological finding of a right lower lobe opacity and minimal inflammatory laboratory changes, which in this context raises the possibility that this represents either an early/mild or subclinical process, or an incidental radiological finding (including atelectasis or a questionable infiltrate of limited clinical significance), rather than the primary cause of the patient’s symptoms.
instead, the predominant symptom is persistent hiccups, which in this case is more plausibly explained either by diaphragmatic irritation from a basal lung process or, more likely, by an underlying gastroesophageal condition (GERD, gastritis, functional dyspepsia), also considering a possible hiatal hernia as a structural contributing factor given the patient’s age, epigastric discomfort, and reduced appetite
therefore, I would recommend not overinterpreting the isolated radiological finding in the absence of clinical infection and, alongside dynamic observation (with chest CT or follow-up imaging if needed), prioritizing a gastroenterological workup, with esophagogastroduodenoscopy (EGD) as the preferred diagnostic step, and if not feasible, initiating a therapeutic trial with a proton pump inhibitor plus a prokinetic agent (e.g., metoclopramide) along with acid-suppressive/antacid therapy (including alginates/antacids) and reassessment of the clinical response.
General Practitioner
First of all, it is important to note the almost complete absence of clinical features of pneumonia (no cough, fever, dyspnea, or pleuritic chest pain), with only a radiological finding of a right lower lobe opacity and minimal inflammatory laboratory changes, which in this context raises the possibility that this represents either an early/mild or subclinical process, or an incidental radiological finding (including atelectasis or a questionable infiltrate of limited clinical significance), rather than the primary cause of the patient’s symptoms.
instead, the predominant symptom is persistent hiccups, which in this case is more plausibly explained either by diaphragmatic irritation from a basal lung process or, more likely, by an underlying gastroesophageal condition (GERD, gastritis, functional dyspepsia), also considering a possible hiatal hernia as a structural contributing factor given the patient’s age, epigastric discomfort, and reduced appetite
therefore, I would recommend not overinterpreting the isolated radiological finding in the absence of clinical infection and, alongside dynamic observation (with chest CT or follow-up imaging if needed), prioritizing a gastroenterological workup, with esophagogastroduodenoscopy (EGD) as the preferred diagnostic step, and if not feasible, initiating a therapeutic trial with a proton pump inhibitor plus a prokinetic agent (e.g., metoclopramide) along with acid-suppressive/antacid therapy (including alginates/antacids) and reassessment of the clinical response.
01.Apr, 06:31pm
Dr. Emad Mohammed
General Practitioner
Yes, pneumonia can be the cause for the hiccups. Few years back, I had a patient with similar complaints, every possible cause was ruled out and finally we did chest CT and found pneumonia. Hiccups resolved in few days of starting antibiotics.
General Practitioner
Yes, pneumonia can be the cause for the hiccups. Few years back, I had a patient with similar complaints, every possible cause was ruled out and finally we did chest CT and found pneumonia. Hiccups resolved in few days of starting antibiotics.
07.Apr, 09:05pm
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