Hiccups, dyspepsia (indigestion) and reflux (stomach acid going into the oesophagus) can affect anyone. If you’re living with a terminal illness, they may be more difficult to manage. But there are medicines that can help manage these symptoms, and things that can help make you feel more comfortable.
This information is written for people living with a terminal illness. But it may also be helpful for carers, family and friends, as well as health and social care professionals.
What are hiccups?
Hiccups are sudden, involuntary contractions of the muscles in the chest that are involved in breathing, including the diaphragm. When we hiccup, air rushes into our lungs against closed vocal cords, making the characteristic ‘hic’ sound.
Most hiccups are harmless and stop within minutes or hours. Hiccups might last up to 48 hours and not be a sign of anything serious.
Hiccups that last between 48 hours and one month are called persistent hiccups. They are also sometimes called protracted hiccups. Hiccups that last for more than one month are called intractable hiccups.
The effect hiccups can have on your life
Persistent or intractable hiccups can be frustrating and distressing. They may disrupt your life by interfering with talking, eating, drinking and sleeping. They can also affect your mood and make any pain you’re experiencing feel worse.
In some cases, hiccups can cause serious complications. These include:
- poor nutrition (malnutrition)
- feeling very tired (fatigue)
- dehydration
- disrupted sleep
- stress, anxiety or depression
- a worse quality of life.
It’s important to speak with your healthcare team about hiccups that are persistent, so they can support you (see Getting support with dyspepsia and reflux below).
What causes hiccups?
There are many different causes of hiccups. If you have a terminal illness, you might have more than one risk factor. Causes include, but are not limited, to:
- stretching of the stomach
- stomach acid going into the oesophagus (gullet) – this is called gastro-oesophageal reflux
- altered blood levels of calcium, magnesium, sodium or potassium
- infection
- damage to the nerve that supplies the diaphragm (the phrenic nerve) – this could be caused by stroke, compression by a tumour, or shingles
- liver disease, including tumours
- medicines including opioids, benzodiazepines and steroids
- stress and anxiety.
The stomach stretching and stomach acid in the oesophagus are the most common causes of hiccups.
Medicines rarely cause hiccups, so do not stop taking your medicines unless you’re advised to by your doctor or specialist nurse.
What helps with hiccups?
If you think there may be an underlying cause for the hiccups, speak to your doctor or nurse and follow their advice.
If there is no underlying cause, try to identify if anything seems to make the hiccups start (triggers). For example, overeating or drinking alcohol. You may want to avoid these things, depending on your priorities. Keeping a diary of when you have hiccups and what you did before they started may help you to identify triggers.
Ways to try to stop hiccups
There are some practical things you can do to try and stop an episode of hiccups, especially if it has started within the last 48 hours. There is not much evidence to show that they work, but lots of people still find that some do work well for them.
Different things might work for different people. You may want to try a few of these to see if any of them help:
- Gargling cold water or swallowing crushed ice.
- Breathing into a paper bag.
- Interrupting normal breathing – for example, holding your breath.
- Drinking water from the far side of a cup.
- Pulling on your tongue.
- Drinking peppermint water.
- Swallowing a teaspoon of dry granulated sugar.
- Compressing the diaphragm by pulling your knees up to your chest.
- Swallowing water while closing your nose.
- Having a sudden fright.
Some people find complementary therapies such as acupuncture and hypnosis helpful.
Getting support with hiccups
Speak to your GP or another member of your healthcare team if:
- the hiccups last for more than 48 hours or
- you’re concerned about what’s causing them or
- you're worried about the effects that they’re having.
They can help assess the hiccups and treat any reversible causes.
If no cause is found, your GP may prescribe peppermint water, anti-sickness medicines, or proton pump inhibitors (PPIs) to reduce stomach acid, such as omeprazole. Peppermint water should not be used if you are taking medicines such as metoclopramide, as they work in opposite ways.
Your GP should review any treatments after three days. If there’s no improvement, a specialist palliative care professional can assess and prescribe other medicines if needed, including dopamine antagonists.
Supporting someone with hiccups towards the end of life
If someone is in their last few days or hours of life, a sedative may help to ease hiccups and make them feel more comfortable. It’s best to speak with the person’s healthcare team to find out what it suitable for them.
Contact our free Support Line on 0800 090 2309 or email support@mariecurie.org.uk to find out how we can support you.
What are dyspepsia and reflux?
Dyspepsia (indigestion) is not one disease. It describes a range of symptoms that affect the stomach and the oesophagus (upper gastrointestinal tract). The symptoms are:
- pain or discomfort in the upper part of the stomach (abdomen)
- heartburn
- reflux
- feeling sick (nausea) or vomiting
- feeling full quickly after eating
- bloating
- belching.
Dyspepsia can be uncomfortable and make your quality of life worse.
Reflux is when stomach acid comes back up into the oesophagus. It can happen as part of dyspepsia or as a symptom on its own.
What causes dyspepsia?
Dyspepsia can affect anyone at any age. If you’re living with a terminal illness, you may be more likely to have dyspepsia. It’s not clear exactly how many people having palliative care have dyspepsia, but it affects at least 1 in 10 (10%) of the general population.
Dyspepsia often does not have any obvious cause. This is called primary or functional dyspepsia. You might not need any treatment for this.
Secondary dyspepsia is when the symptoms occur because of an underlying condition, including:
- gastro-oesophageal reflux disease (GORD)
- an ulcer in the stomach or small intestine (peptic ulcer)
- inflammatory conditions, such as Crohn’s disease
- cancer in the stomach or oesophagus
- infection with Helicobacter pylori (H. pylori) bacteria
- lymphoma affecting the stomach
- the stomach muscles not working properly (gastroparesis) caused by diabetes, renal failure or hypothyroidism
- medicines causing gastroparesis, including opioids, iron supplements, antibiotics and steroids.
What can help with dyspepsia and reflux?
There are things that can help you manage your symptoms. You could try:
- eat smaller portions more often, to avoid feeling full early
- sit up during meals
- raise the head of your bed or use pillows to be propped up in bed
- avoid foods that make your symptoms worse, such as fatty foods and spicy foods
- avoid eating immediately before bed.
Getting support with dyspepsia and reflux
If you have, or are worried you might have dyspepsia, speak to your GP or another member of your healthcare team. They can arrange further assessment to look for underlying causes and prescribe treatment.
If you have pain or heartburn, they might recommend proton pump inhibitors (PPIs) such as omeprazole, or H2 antagonists such as ranitidine. Prokinetics such as metoclopramide help the stomach to work faster. This can be helpful with symptoms of bloating and feeling full.
A community pharmacist may also be able to give advice on medication and eating and drinking. But most of them will not be able to prescribe medication themselves.