Hiccups are caused by sudden, involuntary contractions of the diaphragm, the muscle that separates the chest cavity from the abdominal cavity. This contraction causes the sudden closure of the glottis, which creates the characteristic hiccup sound. Persistent hiccups are defined as lasting for more than two days. Intractable hiccups, or those not easily controlled, are defined as lasting for more than one month, according to Merck Manuals Online Medical Library. Most often, the cause of chronic hiccups is unknown, although an underlying disorder may be responsible.
Gastroesophageal Reflux Disease
Chronic hiccups may be caused by gastroesophageal reflux disease, or GERD. This disorder involves stomach acids backing up into the esophagus, because the esophageal muscles and sphincter fail to prevent the reflux. Risk factors for developing GERD include eating a heavy meal and then lying down, snacking before bed, pregnancy, obesity, respiratory diseases, smoking, alcohol use and hormone replacement therapy, according to the University of Maryland Medical Center, or UMMC. In addition to chronic hiccups, symptoms may include pain, uncomfortable fullness or nausea after eating, heartburn, chest pain, difficulty swallowing and the feeling of acid backing up into the throat. If GERD is left untreated, damage to the esophagus, throat, teeth and airways may result. Permanent changes in esophageal cells may lead to cancer, according to UMMC.
Hiatal Hernia
A hiatal hernia, or diaphragmatic hernia, affects the small opening in the diaphragm that allows the esophagus to connect with the stomach. According to Drugs.com, a hiatal hernia occurs when this opening in the diaphragm, known as the hiatus, is either too large or surrounded by muscles that are too weak, allowing part of the stomach to protrude into the chest cavity. As the stomach slides up and down through the opening or gets trapped in the chest, food and stomach acid backs up into the esophagus. Frequent hiccups, burping, abdominal pain, acidic taste in the mouth, difficulty swallowing, choking, coughing and vomiting are possible symptoms of hiatal hernia. If medications cannot control symptoms, surgical repair is required.
Pericarditis
Pericarditis is an inflammation of the sac surrounding the heart. Although the cause is usually unknown, viral infection, injury to the chest, heart attack and radiation therapy for cancer may be factors. Sharp pain in the center of the chest is the main symptom, according to PeaceHealth. Pain may spread to the shoulder blade or worsen when the patient reclines or takes a deep breath. Persistent hiccups may occur, as well as fatigue, fever and cough. Pericarditis usually resolves within seven to 10 days, but serious complications are possible. Cardiac tamponade may occur if fluid builds up and puts pressure on the heart, stopping the pumping of blood.
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