Idiopathic chronic
hiccup (ICH) is defined as recurring
hiccup attacks that last for longer than an arbitrary time limit (eg, 1 month) and for which no organic cause can be found. In patients with ICH,
therapy is largely empiric. For practical purposes, idiopathic
hiccup can be assumed to have its origin either in the viscera (gastrointestinal tract) or in the central nervous system.
Cisapride and
omeprazole--through reduction of gastric acid production and facilitation of gastric emptying, respectively--are thought to reduce an assumed afferent input from the periphery to a putative supraspinal
hiccup center.
Baclofen is thought to reduce excitability and depress reflex
hiccup activity. Fifteen male patients (mean [+/- SD] age, 68.2 +/- 11.6 years) who had recurring
hiccup attacks for a mean duration of 100.8 +/- 134.1 months (range, 12 to 564 months) were treated for ICH with a combination of
cisapride,
omeprazole, and
baclofen (COB).
Therapy led to a total disappearance of
hiccup in 40% (6 of 15) of the treated patients. An additional 20% (3 of 15) of patients experienced substantial relief. A Mann-Whitney rank order test showed a highly significant reduction in the severity of the
hiccup attacks as reflected in the subjective assessment scale scores taken before
therapy (8.6 +/- 1.3) compared with those taken after 20 weeks of
therapy (4.1 +/- 3.8). Thus we concluded that COB is an effective empiric
therapy in at least some patients with ICH.