Woodley FW, et al. Significant temporal association of esophageal air events (supragastric belches, gastric belches, and air swallows) with hiccups: A case study in an adolescent. Abstracts of the 19th ANMS Annual Meeting, August, 2021 Boston, USA. P.43.

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Авторы: Woodley F.W.  / Williams K.C.  / Di Lorenzo C. / Michel H.K.


Significant temporal association of esophageal air events (supragastric belches, gastric belches, and air swallows) with hiccups: A case study in an adolescent

F.W. Woodley, K. Williams, C. Di Lorenzo, H.K. Michel

Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children’s Hospital, Columbus, OH.

Background: We previously reported our ability to objectively test the temporal association of gastroesophageal reflux disease (GERD) symptoms with esophageal air events (EAEs) that include air-swallows, gastric belching and supragastric belching. We recently evaluated a teenage female presenting with symptoms of recurrent hiccups. We report here the results of a comprehensive 24-hr examination using multichannel intraluminal impedance and pH monitoring (MII-pH).

Methods: Four copies of the MII-pH tracing (Laborie/MMS, Amsterdam, The Netherlands) were generated and each was analyzed either for episodes of gastroesophageal reflux (GER), air-swallowing, gastric belching or supragastric belching, and corresponding symptom association probability (SAP) values were generated. SAP values > 95% were considered significant. Mean lag time durations prior to a hiccup episode for each esophageal disturbance were calculated and compared using a student t test with significance set at α < 0.05.

Results: Recorded during the study were 34 hiccup episodes, 26 GER episodes, 25 supragastric belches, 12 gastric belches and 114 air swallows. Two of the hiccup episodes occurred during feeding and were thus ignored. Hiccups were significantly associated with GER (SAP = 100%), air-swallows (SAP = 99.7%), supragastric belches (SAP = 100%), and gastric belches (SAP = 100%). All but 4 hiccup episodes (87.5%) occurring during fasting or post-prandial periods were preceded by one or more esophageal disturbance. The data show that remarkably more hiccup episodes were preceded by supragastric belches (17 [60.7%]) when compared to air swallows (11 [39.3%]), gastric belches (8 [28.6%]) and GER (11 [39.3%]). The mean time ( ± SD) delay for an air-swallow (60.5 ± 39.2 seconds) prior to a hiccup was significantly longer compared to GER (10.3 ± 4.0 seconds, p = 0.001), gastric belches (9.1 ± 5.9 seconds, p = 0.001) and supragastric belches (10.1 ± 18.2 seconds, p < 0.0001).

Discussion and Conclusion: While the pathophysiology of hiccups is unclear, studies have suggested distension of the proximal esophagus for playing role. Our study, using a novel application of the MII-pH technology, reveals objective data that support a temporal relationship between hiccups and EAEs (including supragastric belches, gastric belches and air swallows). Additional studies are needed to further explain our observations.




Woodley FW, Williams KC, Di Lorenzo C, Michel HK. Significant temporal association of esophageal air events (supragastric belches, gastric belches, and air swallows) with hiccups: A case study in an adolescent. Abstracts of the 19th American Neurogastroenterology and Motility Society Annual Scientific Meeting, August 13–15, 2021, Boston, Massachusetts, USA. № 96.

Neurogastroenterology & Motility. 2021;33(Suppl. 1):e14230. P. 43. wileyonlinelibrary.com/journal/nmo



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