Hiccups occur in normal population, especially when one eats spicy foods or drinks less fluids. Often you cannot pinpoint the cause. The phenomenon of hiccup occurs because of involuntary contraction of one or both domes of the diaphragm (usually both).

The trouble is pronounced, when the symptom becomes a nuisance. This happens especially when the hiccups continue for a longer duration. The public is under the impression that hiccups occur in patients having a serious underlying disease. So the patient must visit a doctor.

In my practice, I have seen hundreds of such patients. These patients include an Indian surgeon from America, who landed with severe intractable hiccups of ten days’ duration. Ten days prior to that, while in USA, he was sent to many specialists (including a gastroenterologist and neurologist) and had also undergone every possible blood test and imaging procedure. After landing in Mumbai, treatment with chlorpromazine aborted the attack.

During my lecture series on 2-3 occasions, I have brought on the stage patients having ‘status hiccupus’. Not only that, on four occasions I have also been lucky to see unilateral hiccups involving only one diaphragm. This phenomenon has been described in literature.

Two things have helped me to know this illness better and to treat it more effectively. The first is that I have been doing dark room fluoroscopy for over 40 years. Thus, in patients coming with continuous persistent hiccups, I have seen the diaphragmatic contractions on fluoroscopy and have been able to explain to the relatives that this is a movement disorder of the group of muscles, which form a partition between the chest and abdomen. Also, with the help of dark room fluoroscopy, I have been able to corroborate that ‘Status Hiccupus’, is nothing but a diaphragmatic flutter which produces a continuous hiccup, thus causing near choking of breath, panic symptoms and a fear of death in the patient. The movements of the diaphragm seen on fluoroscopy during an episode of ‘status hiccupus’, are better than any dance performance seen on the stage.

Secondly, during my tenure as Honorary Physician at JJ Group of Hospitals, I was lucky to have a tetanus ward attached to our unit. In earlier days, we used IV chlorpromazine in very large doses-500 to 1000 milligrams, over 24 hours to control the spasms of tetanus patients. So, I am very confident of the drug, which other doctors are afraid to use in private practice. Administering a dose of 50-100 mg intramuscularly or intravenously should call for no inhibitions. Similarly this drug can be given orally for a few days or weeks to patients having continuous hiccups. Remember that alcohol rehabilitation centres are using the same drug orally for a period of 6 months to 1 year to prevent relapses. The hepatotoxicity of this drug is not more than that of amiodarone, which is freely used, in cardiology practice.

Now coming to the most important part of the article i.e. the word ‘hiccup’ should be given a proper terminology, when it presents as a disease. Neurologists use the term ‘movement disorder’ when skeletal muscles of the body produce involuntary contractions. Gastroenterologists use the word ‘motility disorder’ when organs like oesophagus and colon are involved. Diaphragm is a partly skeletal and partly non-skeletal muscle. Why should we not term this illness as ‘motility or movement disorder’ of diaphragm? Like other motility and movement disorders, when drugs fail to control hiccups (after the initial simple instructions of drinking frequent sips of water, radish juice, cream, honey, etc), interventional treatment is sometimes required. This involves injecting Novocaine in phrenic nerve in the neck, which is equivalent to an injection of botulin toxin in neurological disorders. Similarly, as surgery is offered to patients of movement disorders, when they do not respond to drugs or interventional treatment, rarely surgery in the form of crushing of the phrenic nerve can be advised to patients having resistant hiccups.