Hiccups, indigestion (dyspepsia) and reflux (stomach acid going into the oesophagus) can affect anyone. If you’re living with a terminal illness, they may be harder 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 used for 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
Hiccups that last a long time 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
- 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. They can support you (see Getting support with hiccups during palliative care below).
What causes hiccups at the end of life?
There are many different causes of hiccups. If you have a terminal illness, you might have more than one risk factor for hiccups. 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. Hiccups can also be a complication of some conditions like cancer, multiple sclerosis or Parkinson’s.
Hiccups caused by medication
Medicines do not often cause hiccups. But in some cases, certain medicines may start them. Do not stop taking your medicines unless you’re advised to by your doctor or specialist nurse.
Some examples of medicines that might cause hiccups are:
- dexamethasone
- diazepam
- opioids (for example, morphine and oxycodone)
- anti-epileptics (for example, carbamazepine or gabapentin)
- dopamine agonists (for example, ropinirole).
If you think a medicine might be causing your hiccups, speak to your doctor or specialist nurse. They can assess if it is the cause and advise on the best next steps.
What helps with hiccups?
If you think there may be an underlying cause for the hiccups, speak to your doctor or specialist 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. Think about which methods might be easiest or the most comfortable for you before you try them. 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.
Some people find complementary therapies such as acupuncture and hypnosis helpful.
Getting support with hiccups during palliative care
In palliative care, some ways of controlling hiccups might not be appropriate. So, it’s best to speak to your doctor 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.
To treat hiccups in palliative care, a doctor may prescribe:
- peppermint water
- anti-sickness medicines
- antacid medication, containing simeticone
- 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 doctor 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.
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 is 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 indigestion and reflux?
Indigestion (dyspepsia) is not one disease. It describes a range of symptoms that affect the stomach and the oesophagus. The symptoms are:
- pain or discomfort in the upper part of the stomach (abdomen)
- heartburn
- reflux
- feeling sick or vomiting
- feeling full quickly after eating
- bloating
- belching.
Indigestion 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 indigestion or as a symptom on its own.
What causes indigestion (dyspepsia)?
Indigestion can affect anyone at any age. If you’re living with a terminal illness, you may be more likely to have indigestion. It’s not clear exactly how many people having palliative care experience indigestion. But it affects at least 1 in 10 (10%) of the general population.
Indigestion often does not have any obvious cause. The medical name for this is 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
- inflammatory conditions, such as Crohn’s disease
- cancer in the stomach or oesophagus
- infection with Helicobacter pylori (H. pylori) bacteria
- lymphoma affecting the stomach
- gastroparesis (where food passes through the stomach slower than usual).
What can help with indigestion 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 going to sleep.
Getting support with indigestion and reflux
If you have, or are worried you might have indigestion, 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
- H2 antagonists, such as famotidine.
If you have symptoms of reflux, they might recommend prokinetics, such as metoclopramide. These help the stomach to work faster.
A community pharmacist may also be able to give advice on medication and eating and drinking. They can also advise on how and when to take medicines, and what can help with symptoms