Hiccups after eating spicy food are often due to the irritation of the phrenic nerve or the vagus nerve, which control the diaphragm, leading to involuntary contractions. FOODS.EDU.VN offers comprehensive insights into the science behind this phenomenon and practical tips to prevent and manage spice-induced hiccups. Explore our articles for a deeper understanding of gastrointestinal health and spicy food reactions, including advice on dietary adjustments and natural remedies.
1. What Causes Hiccups After Eating Spicy Food?
Hiccups after eating spicy food are typically triggered by the capsaicin in chili peppers, which can irritate the esophagus and stomach. This irritation can then stimulate the phrenic nerve, which controls the diaphragm, leading to spasms and hiccups. According to a study in the “Journal of Gastroenterology and Hepatology,” nerve irritation is a common cause of hiccups, and spicy foods are a known trigger.
- Nerve Stimulation: Capsaicin, the active component in chili peppers, stimulates nerve endings.
- Esophageal Irritation: Spicy food can irritate the lining of the esophagus.
- Diaphragm Spasms: Nerve stimulation leads to involuntary diaphragm contractions.
1.1. The Role of Capsaicin
Capsaicin is the chemical compound responsible for the spiciness of chili peppers. It binds to pain receptors in the mouth and throat, creating a burning sensation. This sensation can extend to the esophagus and stomach, causing irritation that triggers hiccups. A paper published by the National Institutes of Health details how capsaicin affects sensory neurons, leading to various physiological responses, including hiccups.
- Pain Receptors: Capsaicin activates TRPV1 receptors.
- Burning Sensation: Causes a burning feeling in the mouth and throat.
- Systemic Effects: Can affect the digestive system and trigger hiccups.
1.2. Impact on the Esophagus and Stomach
When spicy food is ingested, it passes through the esophagus and into the stomach. The lining of these organs can be sensitive to capsaicin, leading to inflammation and irritation. This irritation can then stimulate the nerves that control the diaphragm, resulting in hiccups. A study in the “American Journal of Gastroenterology” noted that esophageal sensitivity can be a significant factor in triggering digestive discomfort, including hiccups.
- Esophageal Sensitivity: Some individuals have a more sensitive esophagus.
- Inflammation: Capsaicin can cause inflammation of the digestive tract.
- Nerve Pathways: Irritation activates nerve pathways linked to the diaphragm.
1.3. Connection to the Phrenic Nerve
The phrenic nerve plays a crucial role in controlling the diaphragm, the primary muscle responsible for breathing. When this nerve is stimulated, it can cause the diaphragm to contract involuntarily, leading to hiccups. Spicy food, through its irritating effects on the esophagus and stomach, can indirectly stimulate the phrenic nerve. Research from Harvard Medical School highlights the importance of the phrenic nerve in respiratory functions and its role in conditions like hiccups.
- Diaphragm Control: The phrenic nerve controls diaphragm movement.
- Involuntary Contractions: Stimulation leads to sudden contractions.
- Hiccup Reflex: This nerve is a key component of the hiccup reflex arc.
2. How Spicy Food Triggers Nerve Irritation
Spicy food triggers nerve irritation through a complex interaction involving capsaicin, sensory neurons, and the body’s natural reflexes. Understanding this process can help in managing and preventing spice-induced hiccups.
- Capsaicin Activation: Capsaicin directly activates pain receptors.
- Neurotransmitter Release: This activation leads to the release of neurotransmitters.
- Reflex Arc: The result is a reflex arc that can cause hiccups.
2.1. Activation of Sensory Neurons
When capsaicin comes into contact with the mucous membranes in the mouth, throat, and esophagus, it activates sensory neurons. These neurons are responsible for detecting pain and temperature changes. The activation of these neurons sends signals to the brain, which interprets them as a burning sensation. A study published in “Nature” explains the molecular mechanisms through which capsaicin activates these sensory neurons.
- Mucous Membranes: Capsaicin interacts with membranes in the digestive tract.
- Pain and Temperature: Sensory neurons detect pain and temperature changes.
- Brain Signals: Signals are sent to the brain, resulting in the perception of heat.
2.2. Release of Neurotransmitters
The activation of sensory neurons leads to the release of neurotransmitters, such as substance P and CGRP (calcitonin gene-related peptide). These neurotransmitters play a role in transmitting pain signals and causing inflammation. The release of these substances can further irritate the esophagus and stomach, contributing to the hiccup reflex. Research in the “Journal of Neuroscience” details how these neurotransmitters mediate pain and inflammation in response to capsaicin.
- Substance P: A neurotransmitter involved in pain perception.
- CGRP: Contributes to inflammation and vasodilation.
- Inflammatory Response: Neurotransmitters cause an inflammatory reaction.
2.3. Involvement of the Vagus Nerve
The vagus nerve, one of the longest nerves in the body, connects the brain to various organs, including the stomach and intestines. It plays a significant role in controlling digestion and can be stimulated by the irritation caused by spicy food. Stimulation of the vagus nerve can lead to hiccups, as it is closely linked to the phrenic nerve. Information from Johns Hopkins Medicine explains the extensive functions of the vagus nerve and its impact on overall health.
- Brain-Gut Connection: The vagus nerve connects the brain to the digestive system.
- Digestive Control: It regulates digestive processes.
- Nerve Linkages: Stimulation can affect the phrenic nerve, triggering hiccups.
3. Other Factors That Contribute to Hiccups After Spicy Food
Besides nerve irritation, several other factors can contribute to hiccups after eating spicy food. These include swallowing air, stomach distension, and individual sensitivity.
- Swallowing Air: Can lead to stomach distension.
- Stomach Distension: Triggers nerve responses.
- Individual Sensitivity: Varies from person to person.
3.1. Swallowing Air While Eating
Eating quickly or talking while eating can lead to swallowing excess air. This air can distend the stomach, putting pressure on the diaphragm and irritating the phrenic nerve. When combined with the irritating effects of spicy food, this can increase the likelihood of hiccups. The Mayo Clinic provides guidelines on preventing excessive air swallowing while eating.
- Eating Habits: Eating quickly increases air intake.
- Talking While Eating: Also contributes to swallowing air.
- Diaphragm Pressure: Air distension puts pressure on the diaphragm.
3.2. Stomach Distension
Stomach distension, whether from swallowing air or overeating, can stimulate the vagus nerve and lead to hiccups. The vagus nerve connects the stomach to the brainstem and plays a role in regulating digestion. When the stomach is overly full, it can trigger the hiccup reflex. A study in the “World Journal of Gastroenterology” discusses the mechanisms through which gastric distension can cause various gastrointestinal symptoms, including hiccups.
- Vagus Nerve Stimulation: Distension activates the vagus nerve.
- Overeating: Can cause stomach to expand.
- Reflex Activation: Triggers the body’s natural hiccup reflex.
3.3. Individual Sensitivity to Spicy Food
People vary in their sensitivity to spicy food. Some individuals can tolerate high levels of capsaicin without experiencing any adverse effects, while others are more sensitive and may experience hiccups, heartburn, or other digestive issues. This sensitivity can be influenced by genetic factors, dietary habits, and overall health. Research from the University of California, San Francisco, explores genetic variations that influence pain sensitivity and tolerance to spicy foods.
- Genetic Factors: Influence pain perception.
- Dietary Habits: Regular consumption can increase tolerance.
- Overall Health: Underlying conditions can affect sensitivity.
4. Strategies to Prevent Hiccups When Eating Spicy Food
Preventing hiccups when eating spicy food involves several strategies focused on reducing nerve irritation, avoiding stomach distension, and managing individual sensitivity.
- Eat Slowly: Avoid swallowing excess air.
- Avoid Overeating: Prevent stomach distension.
- Manage Spice Levels: Adjust according to your tolerance.
4.1. Eating Slowly and Mindfully
Eating slowly and mindfully can reduce the amount of air swallowed while eating. It also allows for better digestion and reduces the risk of stomach distension. Taking smaller bites and chewing food thoroughly can make a significant difference. The Academy of Nutrition and Dietetics recommends mindful eating practices to improve digestion and overall health.
- Smaller Bites: Reduces air intake.
- Thorough Chewing: Aids digestion.
- Reduced Distension: Prevents stomach overfilling.
4.2. Avoiding Overeating
Overeating can lead to stomach distension, which can trigger hiccups. Eating smaller, more frequent meals can help prevent this. Listening to your body’s hunger cues and stopping when you feel full can also be beneficial. Information from the National Health Service (NHS) provides advice on portion control and healthy eating habits.
- Smaller Meals: Prevents overfilling.
- Frequent Meals: Maintains steady digestion.
- Hunger Cues: Pay attention to your body’s signals.
4.3. Managing Spice Levels
Adjusting the level of spiciness in your food to match your tolerance can help prevent hiccups. Starting with milder spices and gradually increasing the heat can allow your body to adjust. Also, pairing spicy foods with cooling ingredients like yogurt or cucumber can help reduce the irritating effects of capsaicin. A report from the World Health Organization (WHO) highlights the importance of balanced diets and moderation in consuming potentially irritating substances.
- Gradual Increase: Allows body to adjust.
- Cooling Ingredients: Counteract the heat.
- Moderation: Avoid excessive spice consumption.
5. Effective Home Remedies for Hiccups
If you experience hiccups after eating spicy food, several home remedies can help alleviate them. These remedies often work by stimulating the vagus nerve or distracting the nervous system.
- Breathing Techniques: Regulate nerve function.
- Drinking Water: Soothes the esophagus.
- Distraction Methods: Interrupts the hiccup reflex.
5.1. Breathing Techniques
Various breathing techniques can help stop hiccups. Holding your breath for a short period, breathing into a paper bag (without covering your head), or performing slow, deep breaths can stimulate the vagus nerve and reset the diaphragm. Research from the University of Oxford indicates that controlled breathing exercises can influence the autonomic nervous system, affecting conditions like hiccups.
- Breath Holding: Interrupts the hiccup reflex.
- Paper Bag Breathing: Increases CO2 levels, calming nerves.
- Deep Breaths: Promotes relaxation and vagus nerve stimulation.
5.2. Drinking Water
Sipping ice-cold water slowly can help soothe the irritated esophagus and stimulate the vagus nerve. The cold temperature can also help calm any inflammation. Some people find that drinking water from the far side of a glass or gargling with water can also stop hiccups. A study in the “Journal of Alternative and Complementary Medicine” suggests that cold water can stimulate the vagus nerve, helping to resolve hiccups.
- Esophageal Soothing: Cools and calms the irritated lining.
- Vagus Nerve Stimulation: Influences nerve activity.
- Modified Drinking: Techniques like drinking from the far side of a glass can help.
5.3. Distraction Methods
Distraction methods work by diverting your attention away from the hiccups, interrupting the hiccup reflex. This can include doing mental math problems, listening to music, or engaging in a conversation. These activities can stimulate different parts of the brain, overriding the signals that cause hiccups. A publication from the American Psychological Association (APA) discusses how cognitive distractions can influence physiological responses.
- Mental Stimulation: Diverts brain activity.
- Sensory Engagement: Focuses attention elsewhere.
- Reflex Interruption: Breaks the hiccup cycle.
6. Medical Treatments for Persistent Hiccups
If home remedies do not resolve hiccups, medical treatments may be necessary. Persistent hiccups, lasting longer than 48 hours, can indicate an underlying medical condition and should be evaluated by a healthcare professional.
- Medications: Relax muscles and nerves.
- Medical Procedures: For severe cases.
- Underlying Conditions: Address root causes.
6.1. Medications Commonly Prescribed
Several medications can be prescribed to treat persistent hiccups. These include chlorpromazine, baclofen, and gabapentin. These drugs work by relaxing muscles or affecting nerve activity. A review in the “British Medical Journal” discusses the efficacy and side effects of these medications in treating chronic hiccups.
- Chlorpromazine: An antipsychotic drug used off-label for hiccups.
- Baclofen: A muscle relaxant that can reduce diaphragm spasms.
- Gabapentin: An anticonvulsant that can calm nerve activity.
6.2. Medical Procedures for Severe Cases
In rare cases, medical procedures may be necessary to treat severe, intractable hiccups. These procedures can include nerve blocks, acupuncture, or even surgery to interrupt the phrenic nerve. These interventions are typically reserved for cases where other treatments have failed and the hiccups are significantly affecting the patient’s quality of life. Information from the National Institute of Neurological Disorders and Stroke (NINDS) outlines various medical interventions for neurological conditions, including intractable hiccups.
- Nerve Blocks: Anesthetizing specific nerves to stop signals.
- Acupuncture: Stimulating specific points to regulate nerve function.
- Surgical Interventions: Severing or altering nerve pathways.
6.3. Addressing Underlying Medical Conditions
Persistent hiccups can sometimes be a symptom of an underlying medical condition, such as gastroesophageal reflux disease (GERD), hiatal hernia, or even certain neurological disorders. In these cases, treating the underlying condition can resolve the hiccups. Diagnostic tests and a thorough medical evaluation are necessary to identify and address these underlying causes. A guideline from the American College of Gastroenterology (ACG) provides recommendations for diagnosing and managing GERD and other gastrointestinal disorders.
- GERD Treatment: Managing acid reflux can reduce esophageal irritation.
- Hernia Repair: Correcting hiatal hernias can alleviate diaphragm pressure.
- Neurological Management: Addressing nerve disorders can stabilize nerve function.
7. When to Seek Medical Advice for Hiccups
While most hiccups are harmless and resolve on their own, it is essential to know when to seek medical advice. Persistent hiccups, lasting longer than 48 hours, or hiccups accompanied by other concerning symptoms should be evaluated by a healthcare professional.
- Duration: Longer than 48 hours.
- Accompanying Symptoms: Chest pain, difficulty breathing.
- Impact on Life: Affecting daily activities.
7.1. Hiccups Lasting Longer Than 48 Hours
Hiccups that last longer than 48 hours are considered persistent and may indicate an underlying medical condition. These hiccups should be evaluated by a healthcare professional to determine the cause and appropriate treatment. The National Organization for Rare Disorders (NORD) provides information on various rare conditions that can cause chronic hiccups.
- Persistent Condition: May indicate an underlying issue.
- Professional Evaluation: Necessary to determine the cause.
- Potential Underlying Causes: Could range from minor to severe conditions.
7.2. Hiccups Accompanied by Other Symptoms
If hiccups are accompanied by other symptoms such as chest pain, difficulty breathing, or abdominal pain, it is essential to seek medical advice immediately. These symptoms could indicate a more serious underlying condition affecting the respiratory or digestive system. Information from the American Lung Association (ALA) outlines various respiratory conditions and related symptoms that require prompt medical attention.
- Chest Pain: May indicate heart or lung issues.
- Breathing Difficulty: Could suggest respiratory problems.
- Abdominal Pain: May point to gastrointestinal disorders.
7.3. Hiccups Affecting Daily Life
If hiccups are frequent or severe enough to affect daily activities, such as eating, sleeping, or working, it is important to seek medical advice. Chronic hiccups can significantly impact quality of life and may require medical intervention. A study in “Quality of Life Research” highlights the impact of chronic conditions on daily functioning and overall well-being.
- Impaired Eating: Difficulty consuming meals.
- Sleep Disruption: Affecting rest and recovery.
- Work Interference: Reducing productivity and focus.
8. The Science Behind Spicy Food and the Body
Understanding the science behind how spicy food affects the body can provide valuable insights into managing and preventing adverse reactions, including hiccups.
- Thermoreceptors: Detect heat and pain.
- Endorphin Release: Counteracts pain.
- Metabolic Effects: Influences metabolism.
8.1. Activation of Thermoreceptors
Spicy food activates thermoreceptors, specifically TRPV1 receptors, which are responsible for detecting heat and pain. When capsaicin binds to these receptors, it sends signals to the brain, creating the sensation of heat. This activation is a key component of the body’s response to spicy food. A paper in “Cell” explains the structure and function of TRPV1 receptors and their role in pain and temperature sensation.
- TRPV1 Receptors: Primary detectors of capsaicin.
- Heat Sensation: Signals the brain to perceive heat.
- Pain Perception: Also contributes to pain sensation.
8.2. Endorphin Release and Pain Relief
In response to the pain signals caused by capsaicin, the body releases endorphins, which are natural pain relievers. Endorphins can create a sense of euphoria and well-being, which is why some people enjoy eating spicy food despite the initial discomfort. Research from the University of Michigan explores the role of endorphins in pain modulation and reward pathways.
- Natural Painkillers: Endorphins reduce pain perception.
- Euphoric Effect: Creates a sense of well-being.
- Reward Pathways: Contributes to the enjoyment of spicy food.
8.3. Metabolic Effects of Spicy Food
Spicy food has been shown to have various metabolic effects, including increasing metabolism and promoting weight loss. Capsaicin can stimulate thermogenesis, the process by which the body produces heat, which can burn calories. Additionally, spicy food can help reduce appetite and increase feelings of fullness. A review in the “International Journal of Obesity” discusses the potential benefits of capsaicin in weight management and metabolic health.
- Thermogenesis: Increases heat production, burning calories.
- Appetite Reduction: Helps control hunger.
- Fullness Sensation: Promotes satiety, reducing overall food intake.
9. Dietary and Lifestyle Adjustments to Reduce Hiccups
Making certain dietary and lifestyle adjustments can help reduce the frequency and severity of hiccups, particularly those triggered by spicy food.
- Balanced Diet: Supports overall health.
- Hydration: Maintains bodily functions.
- Stress Management: Reduces nerve sensitivity.
9.1. Maintaining a Balanced Diet
A balanced diet rich in fruits, vegetables, and whole grains can support overall health and reduce the likelihood of digestive issues, including hiccups. Avoiding processed foods, excessive caffeine, and alcohol can also be beneficial. The Dietary Guidelines for Americans provide recommendations for a healthy and balanced diet.
- Nutrient Rich: Provides essential vitamins and minerals.
- Processed Food Reduction: Minimizes additives and irritants.
- Caffeine and Alcohol: Avoid excessive intake to reduce irritation.
9.2. Staying Hydrated
Staying well-hydrated is essential for maintaining bodily functions, including digestion. Drinking plenty of water can help soothe the esophagus and prevent irritation that can lead to hiccups. Water also aids in the efficient processing of food and waste. Harvard T.H. Chan School of Public Health emphasizes the importance of hydration for overall health and provides guidelines for daily water intake.
- Esophageal Soothing: Keeps the lining moist and calm.
- Efficient Digestion: Aids in breaking down food.
- Waste Processing: Facilitates waste removal.
9.3. Managing Stress and Anxiety
Stress and anxiety can contribute to various digestive issues, including hiccups. Practicing stress-reduction techniques such as meditation, yoga, or deep breathing exercises can help calm the nervous system and reduce the frequency of hiccups. The American Institute of Stress provides resources and information on managing stress and its impact on health.
- Nervous System Calming: Reduces sensitivity and reactivity.
- Meditation and Yoga: Promotes relaxation.
- Deep Breathing: Stimulates the vagus nerve, reducing stress.
10. Exploring Cultural Perspectives on Hiccups
Different cultures have unique beliefs and remedies for hiccups. Exploring these perspectives can offer additional insights and alternative approaches to managing this common condition.
- Traditional Medicine: Herbal remedies and practices.
- Superstitions: Beliefs and rituals.
- Dietary Practices: Cultural food habits.
10.1. Traditional Medicine Approaches
Traditional medicine systems, such as Traditional Chinese Medicine (TCM) and Ayurveda, offer various herbal remedies and practices for treating hiccups. These approaches often focus on balancing the body’s energy and promoting overall well-being. The World Health Organization (WHO) recognizes the value of traditional medicine and promotes its integration into healthcare systems.
- Herbal Remedies: Natural compounds to balance the body.
- Acupuncture: TCM practice to stimulate energy flow.
- Ayurvedic Practices: Focus on balancing doshas (energies).
10.2. Superstitions and Folk Remedies
Many cultures have superstitions and folk remedies for stopping hiccups. These can range from simple actions like having someone scare you to more elaborate rituals. While the scientific basis for these remedies may be limited, they often provide a sense of comfort and can sometimes work through the placebo effect. A study in “Psychosomatic Medicine” explores the placebo effect and its influence on health outcomes.
- Scare Tactics: Sudden shock to interrupt the reflex.
- Rituals: Symbolic actions to alleviate the condition.
- Placebo Effect: Belief in the remedy contributing to its success.
10.3. Cultural Dietary Practices
Cultural dietary practices can also influence the occurrence of hiccups. Some cultures have specific foods or eating habits that are believed to trigger or prevent hiccups. Understanding these practices can provide valuable insights into dietary management. A publication from the Food and Agriculture Organization (FAO) explores the diversity of cultural diets and their impact on health.
- Specific Foods: Beliefs about foods that trigger or prevent hiccups.
- Eating Habits: Cultural norms around eating speed and meal composition.
- Dietary Management: Adjusting cultural practices to manage hiccups.
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FAQ: Hiccups After Spicy Food
1. Why Does Spicy Food Sometimes Cause Hiccups?
Spicy food can cause hiccups because capsaicin, the active compound in chili peppers, can irritate the esophagus and stomach, stimulating the phrenic nerve and triggering diaphragm spasms. This nerve irritation leads to the involuntary contractions that characterize hiccups. According to a study in the “Journal of Gastroenterology and Hepatology”, nerve stimulation from spicy foods is a common trigger for hiccups.
2. How Can I Immediately Stop Hiccups After Eating Spicy Food?
To stop hiccups immediately, try breathing techniques like holding your breath for a short period or breathing into a paper bag. Sipping ice-cold water slowly or gargling with water can also help. Distraction methods, such as doing mental math problems, can divert your attention and interrupt the hiccup reflex. These methods are supported by research from the University of Oxford, which indicates that controlled breathing exercises can influence the autonomic nervous system and alleviate hiccups.
3. What Should I Do if My Hiccups Last for More Than 48 Hours?
If your hiccups last for more than 48 hours, it is important to seek medical advice. Persistent hiccups can indicate an underlying medical condition that requires professional evaluation and treatment. The National Organization for Rare Disorders (NORD) provides information on various rare conditions that can cause chronic hiccups, emphasizing the importance of a thorough medical assessment.
4. Are There Any Foods or Drinks I Should Avoid to Prevent Hiccups?
To prevent hiccups, avoid alcoholic, fizzy, or hot drinks. Also, limit chewing gum and smoking, as these can cause you to swallow air. Eating spicy food too quickly or consuming very cold foods immediately after hot ones can also trigger hiccups. The Mayo Clinic offers guidelines on preventing excessive air swallowing and other dietary habits that contribute to hiccups.
5. Can Stress or Anxiety Make Hiccups Worse?
Yes, stress and anxiety can exacerbate hiccups. These conditions can heighten nerve sensitivity and lead to increased frequency and severity of hiccups. Practicing stress-reduction techniques, such as meditation, yoga, or deep breathing exercises, can help calm the nervous system and reduce hiccups. The American Institute of Stress provides resources and information on managing stress and its impact on overall health.
6. How Does Drinking Water Help with Hiccups?
Drinking ice-cold water helps soothe the irritated esophagus and stimulate the vagus nerve, which can reset the diaphragm. Sipping water slowly or gargling with it can also interrupt the hiccup reflex. A study in the “Journal of Alternative and Complementary Medicine” suggests that cold water can stimulate the vagus nerve, helping to resolve hiccups.
7. What Are Some Common Medical Treatments for Chronic Hiccups?
Common medical treatments for chronic hiccups include medications such as chlorpromazine, baclofen, and gabapentin. These drugs work by relaxing muscles or affecting nerve activity. In severe cases, medical procedures such as nerve blocks or surgery to interrupt the phrenic nerve may be necessary. A review in the “British Medical Journal” discusses the efficacy and side effects of these medications in treating chronic hiccups.
8. Is There a Genetic Predisposition to Getting Hiccups from Spicy Food?
While there is no definitive research on a specific genetic predisposition to hiccups from spicy food, individual sensitivity to capsaicin can vary due to genetic factors. Some people have more sensitive pain receptors, making them more prone to nerve irritation from spicy foods. Research from the University of California, San Francisco, explores genetic variations that influence pain sensitivity and tolerance to spicy foods.
9. How Can I Build Tolerance to Spicy Food to Avoid Hiccups?
To build tolerance to spicy food, gradually increase the level of spiciness in your meals over time. Starting with milder spices and slowly adding hotter ones can allow your body to adjust. Pairing spicy foods with cooling ingredients like yogurt or cucumber can also help reduce the irritating effects of capsaicin. A report from the World Health Organization (WHO) highlights the importance of balanced diets and moderation in consuming potentially irritating substances.
10. Can Certain Medical Conditions Cause Hiccups After Eating Spicy Food?
Yes, certain medical conditions, such as gastroesophageal reflux disease (GERD) and hiatal hernia, can make you more prone to hiccups after eating spicy food. These conditions can increase esophageal sensitivity and lead to nerve irritation. Treating the underlying condition can often resolve the hiccups. A guideline from the American College of Gastroenterology (ACG) provides recommendations for diagnosing and managing GERD and other gastrointestinal disorders.