Interventions for treating persistent and intractable hiccups in adults
ABSTRACT 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.
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.
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 Investigators who are known to be carrying out research in this area were contacted for unpublished data or knowledge of the grey literature.
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.
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).
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.
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.
Journal of Hospice and Palliative Nursing 01/2014; 16(7):396-401. DOI:10.1097/NJH.0000000000000087 · 0.48 Impact Factor
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ABSTRACT: Background Limited data exist regarding the efficacy of metoclopramide in the treatment of intractable hiccups.AimsThis study aimed to assess the feasibility efficacy of metoclopramide in the treatment of patients with intractable hiccups.MethodsA total of 36 patients with intractable hiccups were randomly assigned to arm A (n = 18) or arm B (n = 18) in a multi-center, double-blind, randomized, controlled pilot study. Participants in arm A received 10mg metoclopramide thrice daily for 15 days, whereas those assigned to arm B received 10 mg placebo thrice daily for 15 days. The primary outcome measure was total efficacy against hiccups (including cessation and improvement of hiccups). Secondary outcome measures included a comparison of overall efficacy and adverse events between the two arms.ResultsOf the 36 patients enrolled, 34 participants completed the study. The total efficacy was higher in arm A than in arm B (relative risk, 2.75; 95% confidence interval: 1.09–6.94, P = 0.03). Furthermore, comparison between the two arms revealed that overall efficacy was higher in arm A than that in arm B (P < 0.05). No serious adverse events related to the treatment were documented in either arm. The most common adverse events occurring in patients in arm A included fatigue, upset mood, and dizziness.Conclusions Metoclopramide appears to be a promising candidate for the treatment of patients with intractable hiccups, with mild adverse events. However, further clinical trials are required to confirm these results.Internal Medicine Journal 07/2014; DOI:10.1111/imj.12542 · 1.70 Impact Factor
The Journal of neuropsychiatry and clinical neurosciences 01/2015; 27(1):e60. DOI:10.1176/appi.neuropsych.13100307 · 2.77 Impact Factor