Sedation-associated hiccups in adults undergoing gastrointestinal endoscopy and colonoscopy

AIM： To investigate whether the incidence of hiccups in patients undergoing esophagogastroduodenoscopy （EGD） or same-day bidirectional endoscopy （EGD and colonoscopy; BDE） with sedation is different from those without sedation in terms of quantity, duration and typical onset time. METHODS： Consecutive patients scheduled for elec- tive EGD or same-day BDE at the gastrointestinal en- doscopy unit or the health examination center were al- located to two groups： EGD without sedation （Group A） and BDE with sedation （Group B）. The use of sedation was based on the patients＇ request. Anesthesiologists participated in this study by administrating sedative drugs as usual. A single experienced gastroenterologist performed both the EGD and the colonoscopic exami- nations for all the patients. The incidence, duration and onset time of hiccups were measured in both groups. In addition, the association between clinical variables and hiccups were analyzed. RESULTS： A total of 435 patients were enrolled in the study. The incidences of hiccups in the patients with and without sedation were significantly different （20.5% and 5.1%, respectively）. The use of sedation for pa- tients undergoing endoscopy was still significantly asso- ciated with an increased risk of hiccups （adjusted odds ratio： 8.79, P 〈 0.001） after adjustment. The incidence of hiccups in males under sedation was high （67.4%）. The sedated patients who received 2 mg midazolam developed hiccups more frequently compared to those receiving 1 mg midazolam （P = 0.0028）. The patients with the diagnosis of gastroesophageal reflux disease （GERD） were prone to develop hiccups （P = 0.018）. CONCLUSION： Male patients undergoing EGD or BDE with sedation are significantly more likely to suffer from hiccups compared to those without sedation. Midazol- am was significantly associated with an increased risk of hiccups. Furthermore, patients with GERD are prone to develop hiccups.