Identified problems are treated (eg, proton pump inhibitors for gastroesophageal reflux disease, dilation for esophageal stricture).

For symptom relief, many simple measures can be tried, although none are more than slightly effective: PaCO2 can be increased and diaphragmatic activity can be inhibited by a series of deep breath-holds or by breathing deeply in to and out of a paper bag. (CAUTION: Plastic bags can cling to the nostrils and should not be used.) Vagal stimulation by pharyngeal irritation (eg, swallowing dry bread, granulated sugar, or crushed ice, applying traction on the tongue, stimulating gagging) may work. Numerous other folk remedies exist.

Persistent hiccups are often recalcitrant to treatment. Many drugs have been used in anecdotal series. Baclofen, a gamma-aminobutyric acid agonist (5 mg orally every 6 hours increasing to 20 mg/dose), may be effective. Other oral drugs include chlorpromazine 10 to 50 mg 3 times a day as needed, metoclopramide 10 mg 2 to 4 times a day, and various anticonvulsants (eg, gabapentin). Additionally, an empiric trial of proton pump inhibitors may be given. For severe symptoms, chlorpromazine 25 to 50 mg IM or IV can be given.