Abstract
A 75 year-old man with a history of gastroesophageal reflux disease (GERD) suffered from persistent hiccups the day after he was diagnosed to have middle cerebral artery infarction. Although nasogastric tube feeding was started, he developed a repeated bout of aspiration pneumonia caused by gastroesophageal reflux (GER) accompanied by hiccups. Hiccups were intractable and got worsened in parallel with the symptoms of GER. To relieve the reflux symptoms, we tried half-solidification of nutrients in addition to medical treatment with proton pump inhibitors. As a result, hiccups were improved and there was no recurrence of aspiration pneumonia. For dysphagia after stroke, early enteral feeding with a nasogastric tube is recommended as nutritional management in the acute phase. However, we should be careful that mechanical stimulation by a nasogastric tube can also be a worsening factor for patients with hiccups and that hiccups might be refractory due to iatrogenic injury by long-term tube feeding. It should also be noticed that hiccups are part of the atypical symptoms of GERD and can fluctuate correlated with the reflux symptoms. As asymptomatic GERD is common in the elderly, it should be considered as a cause of intractable hiccups. Furthermore, prevention of GER by half-solid nutrients could also lead to the improvement of hiccups.
