Hiccups and Heartburn

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

Hiccups (or hiccoughs) are spasms that affect a muscle between your lungs and stomach that is used when you breathe, called the  diaphragm.

Heartburn is a burning sensation in the throat, chest, or upper abdomen (belly). It's also sometimes called  indigestion.   

Hiccups

When the diaphragm is irritated and suddenly contracts between normal breaths you hiccup. This causes air to be pushed out of the lungs into the trachea. This forces the vocal cords to close quickly making the hiccup sound.

What causes hiccups?

Hiccups can be caused by irritation of the phrenic nerve that controls the diaphragm. Several things can irritate this nerve such as:

• Some cancer medicines, such as certain chemotherapy and targeted drug therapies  
• Medicines to manage side effects, such as steroids and some pain and anxiety medicines
• Nerve or brain damage
• Bloating, gas, or fluid buildup in the abdominal (belly) area
• Low levels of certain electrolytes such as calcium, and potassium
• Tumors or blockages in the esophagus, liver, or pancreas
• Infections
• Stress and anxiety
• Drinking alcohol and smoking

Hiccups are more common in people with advanced cancer.

Treating hiccups

Hiccups usually stop on their own in minutes to hours. But hiccups that continue can cause other problems. They can make it hard for people to eat, drink, sleep, and talk to other people. This can lead to being tired, depressed, and having other mood changes.

• If hiccups last more than 2 days, they can be considered  persistent.
• If hiccups last more than a month, they are considered  intractable.   
• Hiccups that last a long time can be a sign of a serious problem.

If someone has persistent or intractable hiccups, they may need medical treatment.

• Your doctor or cancer care team might prescribe some different medicines for you to help control your hiccups. Each works in a different way so you may need to try more than one before your symptoms are relieved.
• Acupuncture has also been shown to help some people with intractable hiccups.
• A surgical nerve block might be done to prevent the nerve signals that can cause hiccups if medicines don’t stop the hiccups.
• A tube might be placed through your nose into your stomach to remove excess gas or fluid in your belly that is causing hiccups.

Tips for managing hiccups

Many people have their own ways of getting rid of hiccups. Try one or more of these to see if they help.

• Breathe slowly and deeply into a paper bag for 10 breaths at a time.
• Hold your breath as long as you can
• Drink cold 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.
• Sit or lie down and pull your knees to your chest

Call the doctor or cancer care team if you

• Have a hard time eating, drinking, or swallowing
• Have trouble breathing
• Develop a puffy or bloated stomach

Heartburn

If you get heartburn often, it could be a symptom of gastroesophageal reflux disease (GERD). GERD is when your stomach contents back up into the esophagus. Having GERD for many years can lead to ulcers in the esophagus which might increase your risk of cancer of the esophagus.

What causes heartburn?

Anything that causes the stomach to make too much acid or allows the stomach contents to back up into the esophagus can cause heartburn. Some causes are:

• Drinking too much alcohol or caffeine
• Treatments for cancer, such as certain chemotherapy drugs and radiation to the chest or upper abdomen
• Taking certain medications, such as steroids, nonsteroidal anti-inflammatories (aspirin, ibuprofen, naproxen), antibiotics, some heart medicines, and others
• Eating high-fat or spicy foods
• Smoking or using other tobacco products
• Changes in the lining of the esophagus from narrowing or tumor growth

People who are older or have excess body weight are also more likely to have heartburn.

Symptoms of heartburn

Heartburn often feels worse after eating or when you lie down. People with heartburn may also have:

• Bloating and pressure in their belly
• Nausea and vomiting
• A sour taste in their mouth
• A cough or shortness of breath

Treating heartburn

Let your cancer care team know if you have heartburn. There are medicines that might be helpful. Your cancer care team will work with you on a plan to manage your symptoms.  Let them know if the medicines they suggest or prescribe are not working. Also ask your cancer care team if any of the medicines you’re on for other reasons could cause heartburn.

Tips for managing heartburn

There are many things that you can do to help manage your heartburn.

• Avoid tobacco and alcohol
• Limit the amount of fatty food you eat, such as fried food
• Stay away from foods that can make heartburn worse, like chocolate, garlic, onions, mints, and sweets.
• Try chewing gum so that you make more saliva
• Eat small meals rather than big ones
• Drink fluids after eating to help with swallowing.
• Sit up for a while after you eat
• Eat at least 2 hours before lying down or going to bed.
• Elevate the head of your bed about 6 inches
• If you are overweight, talk to your health care team about losing weight
• It can also help to keep a record of when you get heartburn. Be sure to include what you were doing when it started and if you were eating or had just eaten something. Also include anything that helps relieve your symptoms.

Call the doctor or cancer care team if you

• Have a hard time eating, drinking, or swallowing
• Have trouble breathing
• Develop a puffy or bloated stomach or constipation
• Have chest pain, dizziness, or sweating