Hiccups are a common physiological phenomenon experienced by individuals of all ages, typically brief and self-limiting. Medically termed singultus, hiccups result from involuntary contractions of the diaphragm followed by sudden closure of the vocal cords. While usually benign, persistent or recurrent hiccups may indicate underlying gastrointestinal, neurological, or metabolic conditions. Research has increasingly examined the association between hiccups, indigestion, and gastroesophageal reflux disease (GERD).

What Are Hiccups?

Hiccups are defined as sudden, involuntary spasms of the diaphragm accompanied by abrupt glottic closure, producing the characteristic “hic” sound. They can occur sporadically or persist for extended durations.

Based on duration, hiccups are clinically classified as:

• Acute: lasting less than 48 hours

• Persistent: lasting more than 48 hours

• Intractable: lasting longer than one month

Persistent and intractable hiccups are uncommon but are more likely to be associated with underlying disease processes.

Physiological Mechanism of Hiccups

The Hiccup Reflex Arc

Hiccups are mediated by a reflex arc involving:

• Afferent pathways: vagus nerve, phrenic nerve, and sympathetic fibers

• Central processing: brainstem (medulla oblongata)

• Efferent pathways: phrenic nerve supplying the diaphragm

Disruption or stimulation at any point in this reflex arc can trigger hiccups. The sudden diaphragmatic contraction draws air into the lungs, while reflex closure of the glottis generates the audible sound.

Common Causes of Hiccups

Physiological and Benign Triggers

Short-lasting hiccups are commonly triggered by:

• Rapid eating or drinking

• Gastric distension

• Carbonated beverages

• Sudden temperature changes

• Emotional stress

These triggers often stimulate the vagus nerve or diaphragm indirectly.

Medical Conditions Associated With Hiccups

Persistent or recurrent hiccups may be associated with:

• Gastrointestinal disorders, including GERD and dyspepsia

• Central nervous system disorders, such as stroke or tumors

• Metabolic disturbances, including renal failure and electrolyte imbalance

• Medications, particularly corticosteroids and benzodiazepines

Among these, gastrointestinal causes are among the most frequently reported.

Indigestion, GERD, and Hiccups: Is There a Connection?

Indigestion (Dyspepsia)

Indigestion refers to upper abdominal discomfort characterized by bloating, nausea, early satiety, and epigastric pain. Gastric distension and delayed gastric emptying may mechanically stimulate the diaphragm or vagus nerve, potentially triggering hiccups.

Gastroesophageal Reflux Disease (GERD)

GERD is characterized by the backward flow of gastric contents into the esophagus, leading to mucosal irritation. Studies suggest that acid reflux can stimulate vagal afferents, thereby activating the hiccup reflex arc.

Clinical observations and case reports have documented hiccups as a presenting symptom of GERD, with symptom resolution following acid-suppressive therapy.

Evidence From Clinical Studies

• A review published in Current Treatment Options in Gastroenterology identifies GERD as a common and treatable cause of persistent hiccups.

• Case reports demonstrate hiccups resolving after treatment with proton-pump inhibitors in patients with reflux-associated symptoms.

• A comprehensive review in Canadian Family Physician highlights gastrointestinal pathology as one of the leading contributors to chronic hiccups.

These findings support a pathophysiological link between reflux, indigestion, and hiccups, particularly in persistent cases.

When Do Hiccups Require Medical Evaluation?

Medical assessment is generally recommended when hiccups:

• Persist longer than 48 hours

• Interfere with sleep or nutrition

• Are accompanied by neurological or gastrointestinal symptoms

In such cases, evaluation may include imaging, laboratory testing, or gastrointestinal studies to identify underlying causes.

Summary of Key Points

• Hiccups are involuntary diaphragmatic contractions mediated by a neural reflex arc.

• Most episodes are benign and self-limited.

• Persistent hiccups may be linked to gastrointestinal conditions, especially GERD and indigestion.

• Acid reflux can stimulate vagal pathways involved in the hiccup reflex.

• Recognition of underlying causes is essential in prolonged cases.

References

1. de Hoyos A, Esparza EA, Cervantes-Sodi M. "Non-erosive reflux disease manifested exclusively by protracted hiccups." Journal of Neurogastroenterology and Motility. 2010 Oct;16(4):424-7. Accessed January 2026. https://www.ncbi.nlm.nih.gov/pcmc/articles/PMC2978396/.

2. Jothi Priya, and Nivesh Krishna R. 2021. “The Pathophysiology of Hiccups: A Comprehensive Review.” International Journal of Scientific Development and Research (IJSDR) 6, no. 7 (July). ISSN 2455-2631.
   https://www.ijsdr.org/papers/IJSDR2107006.pdf.

3. Koçkar, Cem, Mehmet Işler, Erkan Cüre, Altuğ Şenol, and Abdulkadir Basturk. 2009. “Hiccup Due to Gastroesophageal Reflux Disease.” European Journal of General Medicine 6, no. 4. Accessed January 2026. https://www.researchgate.net/publication/45316165_Hiccup_due_to_gastroesophageal_reflux_disease.

4. Marie Curie. 2026.
   “Hiccups, Dyspepsia and Reflux.” Accessed January 2026. https://www.mariecurie.org.uk/information/symptoms/hiccups-dyspepsia-and-reflux.