Interventions for treating persistent and intractable hiccups in adults Stable (no update expected for reasons given in 'What's new')

Abstract

Abstract Background

Persistent and intractable hiccups (typically defined as lasting for more than 48 hours and one month respectively) can be of serious detriment to a patient's quality of life, although they are relatively uncommon. A wide range of pharmacological and non‐pharmacological interventions have been used for the treatment of persistent and intractable hiccups. However, there is little evidence as to which interventions are effective or harmful.

Objectives

The objective of this review was to evaluate the effectiveness of pharmacological and non‐pharmacological interventions used in the treatment of persistent and intractable hiccups of any aetiology in adults.

Search methods

Studies were identified from the following databases: CENTRAL, CDSR, DARE, MEDLINE, EMBASE, CINAHL, PsychINFO and SIGLE (last search March 2012). The search strategy for all the databases searched was based on the MEDLINE search strategy presented in Appendix 1. No additional handsearching of journals was undertaken. Investigators who are known to be carrying out research in this area were contacted for unpublished data or knowledge of the grey literature.

Selection criteria

Studies eligible for inclusion in this review were randomised controlled trials (RCTs) or controlled clinical trials (CCTs). Inclusion criteria: adults (over 18 years old) diagnosed with persistent or intractable hiccups (hiccups lasting more than 48 hours), treated with any pharmacological or non‐pharmacological intervention. Exclusion criteria: less than ten participants; no assessment of change in hiccup frequency or intensity in outcome measures.

Data collection and analysis

Two independent review authors assessed each abstract and title for relevance. Disagreement on eligibility was resolved by discussion. Where no abstract was available the full paper was obtained and assessed. We obtained full copies of the studies which met the inclusion criteria for further assessment. Two review authors independently collected data from each appropriate study and entered them into the software Review Manager 5. Two independent review authors assessed the risk of bias using the RevMan 5 'Risk of bias' table following guidance from the Cochrane Handbook of Systematic Reviews of Interventions (Higgins 2009).

Main results

A total of four studies (305 participants) met the inclusion criteria. All of these studies sought to determine the effectiveness of different acupuncture techniques in the treatment of persistent and intractable hiccups. All four studies had a high risk of bias, did not compare the intervention with placebo, and failed to report side effects or adverse events for either the treatment or control groups. Due to methodological differences we were unable to perform a meta‐analysis of the results. No studies investigating pharmacological interventions for persistent and intractable hiccups met the inclusion criteria.

Authors' conclusions

There is insufficient evidence to guide the treatment of persistent or intractable hiccups with either pharmacological or non‐pharmacological interventions.

The paucity of high quality studies indicate a need for randomised placebo‐controlled trials of both pharmacological and non‐pharmacological treatments. As the symptom is relatively rare, trials would need to be multi‐centred and possibly multi‐national.

Author(s)

Emilia N Moretto, Bee Wee, Philip J Wiffen, Andrew G Murchison

Abstract

Plain language summary

Interventions for treating persistent and intractable hiccups in adults.

Hiccups involve repeated, involuntary contractions of the muscles used for breathing. They usually stop of their own accord; rarely, however, they may last for more than 48 hours. When they do persist, hiccups can cause a patient considerable upset, interfere with sleeping and eating, and can lead to other complications. Many different drugs and non‐drug measures have been suggested to stop long‐lasting hiccups. This review aimed to find out whether there is good evidence that any of these work. We searched for good quality studies that involved adult patients (18 or older) who had experienced hiccups for 48 hours or more. Our conclusion is that there is insufficient evidence to recommend a particular treatment for hiccups. There is a need for randomised controlled studies to identify which treatments might be effective or harmful in treating persistent hiccups.

Author(s)

Emilia N Moretto, Bee Wee, Philip J Wiffen, Andrew G Murchison

Reviewer's Conclusions

Authors' conclusions

Implications for practice

There is insufficient evidence to guide the treatment of persistent or intractable hiccups either pharmacologically or non‐pharmacologically. Four randomised controlled trials demonstrated that acupuncture may be effective in the treatment of persistent and intractable hiccups. However these results should be interpreted with caution as the studies were not blinded or placebo‐controlled, and did not report potential side effects, therefore these treatments may be no better than placebo.There are several larger case series looking at the use of baclofen or gabapentin for the treatment of persistent and intractable hiccups.

Implications for research

There is a paucity of high quality studies examining the effectiveness of pharmacological or non‐pharmacological interventions for persistent and intractable hiccups. This may be because persistent and intractable hiccups are a relatively rare and under‐reported symptom. In order to guide the treatment of this disabling condition there is a need for randomised placebo‐controlled trials of both pharmacological treatments and non‐pharmacological treatments. As the condition is relatively rare, trials would probably have to be multi‐centred and possibly multi‐national. Ideally, the comparison of pharmacological versus non‐pharmacological treatments would enable clinicians to make more informed decisions, giving information about effectiveness of the different treatment options and potential side effects. Furthermore, longer‐term follow‐up would allow the length of action of the treatments and the burden of treatments to be compared.

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