Hiccups and Heartburn

Cancer and its treatment can sometimes cause hiccups or heartburn. It's important to know that other non-cancer problems and medicines can also cause them or increase the risk for them.

Hiccups

Hiccups (or hiccoughs) are spasms that affect a muscle between your lungs and stomach that is used when you breathe, called the diaphragm. A hiccup happens when the diaphragm is irritated and suddenly contracts between normal breaths.

Hiccups can be caused by irritation of the nerve that controls the diaphragm which can happen for different reasons, such as:

  • Certain chemotherapy drugs used to treat cancer
  • Other drugs that may or may not be taken for cancer-related problems, including steroids, anti-nausea medicines, and antibiotics
  • Nerve or brain injuries
  • Fluid in the lungs or near the heart
  • Bloating and gas in the stomach area
  • Low levels of certain electrolytes (blood chemistries) such as sodium, calcium, and potassium
  • High blood sugar level
  • Problems in the esophagus (the swallowing tube that goes from the throat to the stomach)
  • Tumors or blockages in the esophagus, lungs, liver, pancreas, kidney, or colon
  • Changes in temperature
  • Stress and excitement
  • Drinking certain types of liquids or eating certain foods.

In people with cancer, certain chemotherapy drugs can have hiccups as a side effect,

Hiccups are usually temporary and stop within minutes to hours. If hiccups last more than 2 days, they can be considered persistent; they are considered intractable if they last more than a month. Hiccups that last a long time can be a sign of a serious problem.

Managing hiccups

There is a medication that can be prescribed to help manage hiccups if needed. But usually they are very temporary and stop without any kind of treatment. There’s not a lot of research about ways to manage hiccups other than using medication your doctor prescribes, but here are some things people have found useful.

  • Breathe slowly and deeply into a paper bag for 10 breaths at a time.
  • Drink water slowly.
  • Bear down gently as if having a bowel movement (called the Valsalva maneuver).
  • Hold a teaspoon of sugar in your mouth and then swallow.
  • Avoid forcing yourself to eat.

Heartburn

Heartburn is a burning sensation in the throat, chest, or upper abdominal (belly) area that often worsens after eating or when you lay down. Some people might notice it more in the evening or after going to bed at night. It's sometimes called indigestion or acid reflux. It's a common problem from having too much acid in the stomach that forces contents of the stomach up into the esophagus.

If heartburn happens frequently it is often called or diagnosed as gastroesophageal reflux disease (GERD). Sometimes, several years of heartburn can lead to ulcers or Barrett's esophagus which is linked to an increased risk of cancer of the esophagus.

Causes of heartburn include:

  • Increased production of stomach acid
  • Drinking too much alcohol, caffeine, acidic juices, or carbonated beverages
  • Treatments for cancer, such as certain chemotherapy drugs and radiation to the chest or upper abdomen
  • Taking certain medications, such as aspirin and anti-inflammatories (Advil, Motrin, Aleve, ibuprofen)
  • Eating high-fat foods
  • Smoking
  • Being obese
  • Blockages or changes in structure of the esophagus due to narrowing or tumor growth

Managing heartburn

Your health care team may prescribe an over-the-counter antacid to help with heartburn. There are other medications that might be prescribed short-term. Talk with your health care team if you have heartburn, and if any recommended or prescribed medications are not working.

  • Avoid tobacco
  • Limit caffeine and alcohol
  • If you are overweight, losing weight may help relieve symptoms
  • Eat small rather than big meals
  • Avoid eating less than 2 to 3 hours before bedtime

What caregivers can do for hiccups and heartburn

  • Watch the patient to be sure that they’re able to drink enough liquid.
  • Elevate the head of the bed for comfort.
  • If medicine is given, watch for dizziness. The patient may need help getting up or walking.

Call the health care team if the patient

  • Has nausea that isn't managed even after taking medication
  • Has trouble breathing, eating, or swallowing
  • Has heartburn and develops a puffy or bloated stomach or constipation

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Lohr L. Treatment of hiccups in patients with cancer. Oncology Times. 2018;40(7):10,48-49.

Kang JH, Bruera E. Hiccups during chemotherapy: What should we do? J Pall Med. 2015;18:572.

Kroch DA, Madanick RD. Medical treatment of gastroesophageal reflux disease. World J Surg. 2017;41(7):1678-1684.

National Comprehensive Cancer Network. Palliative Care. Version 2.2019. Accessed at www.nccn.org/professionals/physician_gls/pdf/palliative.pdf on September  19, 2019.

Steger M, Schneemann M, Fox M. Systemic review: The pathogenesis and pharmacological treatment of hiccups. Alimentary Pharmacology & Therapeutics. 2015;2(9):1037-50. Accessed at https://onlinelibrary.wiley.com/doi/full/10.1111/apt.13374 on January 2, 2020.

Zaterka S, Marion SB, Roveda F, Perrotti MA, Chinzon D. Historical perspective of gastroesophageal reflux disease clinical treatment. Arq Gastroenterol. 2019;56(2):202-208.

 

 

 

References

Lohr L. Treatment of hiccups in patients with cancer. Oncology Times. 2018;40(7):10,48-49.

Kang JH, Bruera E. Hiccups during chemotherapy: What should we do? J Pall Med. 2015;18:572.

Kroch DA, Madanick RD. Medical treatment of gastroesophageal reflux disease. World J Surg. 2017;41(7):1678-1684.

National Comprehensive Cancer Network. Palliative Care. Version 2.2019. Accessed at www.nccn.org/professionals/physician_gls/pdf/palliative.pdf on September  19, 2019.

Steger M, Schneemann M, Fox M. Systemic review: The pathogenesis and pharmacological treatment of hiccups. Alimentary Pharmacology & Therapeutics. 2015;2(9):1037-50. Accessed at https://onlinelibrary.wiley.com/doi/full/10.1111/apt.13374 on January 2, 2020.

Zaterka S, Marion SB, Roveda F, Perrotti MA, Chinzon D. Historical perspective of gastroesophageal reflux disease clinical treatment. Arq Gastroenterol. 2019;56(2):202-208.

 

 

 

Last Revised: February 1, 2020

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