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Neurological Rehabilitation

Intractable Hiccups due to Gastric Distention Coinciding with Multiple Posterior Circulation Strokes: A Case Report

Saturday, October 25, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 5

    Primary Author(s)

  • Elizabeth Chang, MD

    Resident Physician
    Schwab Rehabilitation Hospital & Care Network/University of Chicago PM&R Program
    Chicago, Illinois

    • Co-Author(s)

  • Steven Le, MD

    Resident Physician
    Schwab Rehabilitation Hospital & Care Network/University of Chicago PM&R Program
    Chicago, Illinois

  • GA

    Ghada R. Ahmed, MD

    Attending Physician
    Mount Sinai hospital
    Chicago, Illinois

Disclosure(s):
Elizabeth Chang, MD: No financial relationships to disclose
Steven Le, MD: No financial relationships to disclose
Case Diagnosis: 59-year-old male with a recent history of three posterior circulation strokes

Case Description or Program Description: A patient with a history of type II diabetes, severe vertebrobasilar intracranial atherosclerotic disease, and a recent history of three posterior circulation strokes in a one month period despite maximum medical therapy complicated by aphasia and severe dysphagia requiring gastrostomy tube placement was found to have intractable daytime hiccups ongoing for one month. Hiccups were previously treated with baclofen, gabapentin, and thorazine without symptomatic control. Patient was weaned off thorazine and started on metoclopramide, bolus feeds were changed to a high calorie formulation to minimize total feed volume, his bowel program was optimized for daily bowel movements, and scheduled simethicone was started to minimize abdominal distension.

Setting: Acute inpatient rehabilitation

Assessment/Results: Patient experienced resolution of hiccups following treatment with scheduled metoclopramide, initiation of high calorie lower volume enteral feeds, and optimization of bowel program, enabling him to participate in swallow evaluations and progress with aphasia rehabilitation.

Discussion (relevance): This is a unique case of intractable hiccups likely due to gastric distension from bolus enteral feeds in the setting of slowed gastric motility due to diabetes. Adequate control of patient’s symptoms through pharmacologic and dietary strategies allowed him to progress with dysphagia and aphasia rehabilitation, which were previously hindered due to hiccup burden. Given that hiccups can arise from both central and peripheral causes, it is important to determine their origin in order to guide appropriate treatment, reduce patient discomfort, and optimize functional recovery, especially in cases of comorbid dysphagia and aphasia.

Conclusions: Intractable hiccups may hinder dysphagia and aphasia rehabilitation. Even when central causes are suspected, a comprehensive evaluation of gastrointestinal etiologies, such as gastric distention, is essential. A multimodal approach with pharmacologic therapy, along with optimization of nutrition and bowel management should be considered to control symptoms and facilitate progress in rehabilitation.