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Gastrointestinal Neurological

Hiccups

Last revised in April 2026

Hiccups involve an involuntary (reflex) diaphragmatic contraction, causing sudden inspiration.

Hiccups: Summary

  • Hiccups involve an involuntary (reflex) diaphragmatic contraction, causing sudden inspiration. The incoming air is stopped by closure of the glottis which produces a characteristic sound. Hiccups do not appear to perform any useful or protective function.
    • Transient hiccups are usual and last less than 48 hours.
    • Persistent or protracted hiccups are rare and last more than 48 hours.
  • Persistent hiccups may cause complications (for example, fatigue and weight loss).
  • If hiccups have lasted more than 48 hours, a full assessment should be performed to assess whether there is an underlying cause. This may require referral to secondary care. Investigations that may be considered in primary care include:
    • Full blood count (abnormal findings include leukocytosis in inflammation or infection, and anaemia in malignancy or GI haemorrhage).
    • Urea and electrolytes (to exclude uraemia, hyponatraemia, hypokalaemia, and hypocalcaemia)
    • Erythrocyte sedimentation rate or C-reactive protein level (an elevated level suggests the presence of an underlying disease).
    • Liver function tests (abnormal results may indicate hepatitis, liver metastases).
    • Electrocardiogram (to exclude pericarditis, recent myocardial infarction).
    • Chest radiograph (to exclude lung pathology).
  • The management of recurrent short episodes of hiccups involves offering advice on avoiding trigger factors, and suggesting the following self-help remedies:
    • Stimulation of the nasopharynx: sipping iced water, swallowing granulated sugar, tasting vinegar, biting on a lemon.
    • Interruption of normal respiratory function: Valsalva manoeuvre, breath holding, hyperventilating, breathing into a paper bag, sneezing.
    • Counter-irritation of the diaphragm: pulling the knees up to the chest.
  • The management of persistent or intractable hiccups involves offering advice on avoiding trigger factors, suggesting self-help remedies, and management of any identified underlying cause in primary or secondary care, or if a cause cannot be identified:
    • Offering advice on trying hypnotherapy, acupuncture, or psychotherapy.
    • Utilizing techniques to interrupt of the hiccup reflex arc (some of which require specialist referral).
    • Considering specialist referral for initiation of pharmacotherapy.
    • Consideration of referral for phrenic nerve disruption.
  • Follow-up should be carried out at an interval determined by clinical judgement, and the person advised to report any signs of complications such as cardiac arrhythmias, insomnia, weight loss, and oesophagitis.

Have I got the right topic?

From birth onwards.

This CKS topic is largely based on the BMJ Best Practice guide Hiccups [BMJ Best Practice, 2026], the Scottish Palliative Care Guideline Hiccups [HIS, 2021], and expert opinion in narrative reviews Management of hiccups in palliative care patients [Jeon, 2018], Hiccups in neurocritical care [Rajagopalan, 2021], and Hiccups: a non-systematic review [Leung 2020].

This CKS topic covers the management of transient, persistent, and intractable hiccups (also called 'hiccoughs' or 'singultus').

This CKS topic does not cover the use of drug treatments for intractable hiccups in children.

There is a separate CKS topic on Dyspepsia - unidentified cause.

The target audience for this CKS topic is healthcare professionals working within the NHS in the UK, and providing first contact or primary healthcare.

How up-to-date is this topic?

Changes

April 2026 — reviewed. A literature search was conducted in March 2026 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No changes have been made to the recommendations.

Previous changes

February 2022 — reviewed. A literature search was conducted in January 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to recommendations have been made.

June 2017 — reviewed. A literature search was conducted in June 2017 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The topic has undergone restructuring. No major changes to the recommendations have been made.

November 2012 — minor update. The links to the electronic medicines website (www.medicines.org.uk) have been updated.

September 2012 — reviewed. A literature search was conducted in September 2012 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of the topic. No changes to clinical recommendations have been made.

July to November 2008 — converted from CKS guidance to CKS topic structure. The evidence-base has been reviewed in detail, and recommendations are more clearly justified and transparently linked to the supporting evidence. There have been minor changes to the section on recommended drugs and dosages.

June 2005 — reviewed. Validated in September 2005 and issued in November 2005.

January 2002 — reviewed. Validated in March 2002 and issued in April 2002.

October 1998 — written, replacing guidance on Hiccough and Psychogenic hiccough.

Update

New evidence

Evidence-based guidelines

No new evidence-based guidelines since 1 April 2026.

HTAs (Health Technology Assessments)

No new HTAs since 1 April 2026.

Economic appraisals

No new economic appraisals relevant to England since 1 April 2026.

Systematic reviews and meta-analyses

No new systematic reviews published since 1 April 2026.

Primary evidence

No new primary evidence which reaches the CKS threshold for inclusion published since 1 April 2026.

New policies

No new national policies or guidelines since 1 April 2026.

New safety alerts

No new safety alerts since 1 April 2026.

Changes in product availability

No changes in product availability since 1 April 2026.

Goals and outcome measures

Goals

To support primary healthcare professionals to:

  • Treat hiccups in primary care settings if appropriate.
  • Provide relevant advice.
  • Refer to secondary care or other specialist services where appropriate.

Outcome measures

No outcome measures were found during the review of this topic.

Audit criteria

No audit criteria were found during the review of this topic.

QOF indicators

No QOF indicators were found during the review of this topic.

QIPP - Options for local implementation

No QIPP indicators were found during the review of this topic.

NICE quality standards

No NICE quality standards were found during the review of this topic.

Background information

What are hiccups?

  • A hiccup (or hiccough) is also known as singultus, from the Latin meaning 'a gasp' or 'a sob'.
  • It is an abrupt contraction of the inspiratory muscles repeating several times per minute. The resultant rush of air into the lungs causes the glottis to close, creating a characteristic sound. 
  • Hiccups can be classified as: 
    • Acute — hiccups last for minutes to hours and are usually benign and self-limiting, lasting for less than 48 hours.
    • Persistent (chronic) or protracted — hiccups last for more than 48 hours.
    • Intractable — hiccups last for more than 1 month.

[Rajagopalan, 2021]

How common are hiccups?

  • Benign hiccups are very common and affect people of all ages. 
  • Males are affected more than females, and this is more pronounced in non-central nervous system causes of hiccups. 
  • The prevalence of hiccups in people with advanced cancer has been reported as 3.9–4.8%. 
  • Up to 20% of people with Parkinson’s disease and 10% of people with reflux symptoms report recurrent hiccups compared to approximately 3% of healthy individuals. 

[Lee, 2016; Rajagopalan, 2021]

What are the causes?

  • Benign hiccups can be caused by:
    • Gastric distension from aerophagia, excessive food and alcohol consumption, and drinking carbonated beverages. 
    • Irritants to the gastrointestinal (GI) or pulmonary tracts such as spicy food or smoking.
    • Sudden changes in ambient or GI temperature caused by cold showers or hot or cold beverages. 
    • Sudden excitement. 
    • Emotional stress and anxiety.
  • Persistent hiccups can be caused by:
    • Peripheral pathologies — irritation of the diaphragmatic, phrenic, and vagus nerves.
      • Underlying causes of diaphragmatic and phrenic nerve irritation include: subphrenic abscess, splenomegaly, hepatomegaly, myocardial infarction, pericarditis, hiatus hernia, oesophageal cancer, or an aberrant cardiac pacemaker electrode. 
      • Underlying causes of vagus nerve irritation can result from pathologies which interfere with its function at any point along the length of the nerve: a foreign body irritating the tympanic membrane, pharyngitis, laryngitis, goitre or neck cyst, pneumonia, empyema, bronchitis, asthma, pleuritis, oesophagitis, aortic aneurysm, tuberculosis, lung cancer, cor pulmonale, mediastinitis, gastric atony, gastric cancer, gastritis, duodenal ulcer, pancreatitis, pancreatic cancer, intra-abdominal abscess, bowel obstruction, cholecystitis, cholelithiasis, ulcerative colitis, Crohn's disease, gastrointestinal haemorrhage, appendicitis, hepatitis, or prostatic disease.
    • Central nervous pathologies, including: 
      • Structural lesions — intracranial neoplasm, syringomyelia, multiple sclerosis, ventriculo-peritoneal shunt.
      • Vascular lesions — intracranial haemorrhage or infarction, arterio-venous malformation, vascular insufficiency. 
      • Infection — meningitis, encephalitis, neurosyphilis, malaria, herpes zoster.
      • Trauma. 
      • Epilepsy.
    • Metabolic causes — uraemia, diabetes mellitus, gout, hyponatraemia, hypocalcaemia, hypocapnia, hypokalaemia, and alkalosis. 
    • Surgical causes — bronchoscopy, tracheostomy, thoracic or abdominal surgeries, central venous catheterization. 
    • Exposure to alcohol and certain medications — such as dexamethasone, diazepam, opioids, sulfonamides, anti-epileptics, dopamine agonists and alpha-methyldopa.
    • Psychiatric conditions — anorexia nervosa, schizophrenia, and functional neurological disorder. 
    • Psychogenic disorders — acute anxiety, stress, fear, or excitement.

[Leung 2020; Rajagopalan, 2021; BMJ Best Practice, 2026]

What is the prognosis?

  • Benign hiccups are self-limiting by their nature. They can often be averted by avoiding predisposing factors. 
  • Persistent hiccups can sometimes last for many years. Treatment of an underlying cause may lead to their cessation. 
  • Reports indicate that there can sometimes be a sudden and unexpected termination of persistent hiccups, even after years. 

[Leung 2020; BMJ Best Practice, 2026]

What are the complications?

Complications of chronic hiccups in primary care include:

  • Gastro-oesophageal reflux.
  • Weight loss, malnutrition, and dehydration — caused by persistent hiccups affecting the person's ability to eat normally.
  • Cardiac arrhythmias — resulting from severe diaphragmatic contractions.
  • Sleep deprivation, extreme fatigue.
  • Depression, anxiety and reduced quality of life — caused by persistent hiccups interfering with eating, social interaction and sleep.

[Hendrix, 2019; Rajagopalan, 2021; BMJ Best Practice, 2026]

Diagnosis of hiccups

How should I assess a person with recurrent or protracted hiccups for an underlying cause?

If the person has recurrent bouts of hiccups that persist for less than an hour, ask about exposure to potential triggers such as:

  • Sudden excitement and emotional stress. 
  • Sudden changes in ambient or gastrointestinal temperature (cold showers, or drinking hot or cold beverages). 
  • Drinking carbonated beverages. 
  • Excessive food or alcohol consumption. 
    • If no clear trigger is identified, and/or the person reports other symptoms or complications, use clinical judgement to determine whether a physical examination and baseline investigations are appropriate.

If the person has hiccups that have persisted for longer than 48 hours, or recurrent bouts of hiccups that persist for longer than an hour:

  • Ask about:
    • Duration and intensity. 
    • Whether hiccups continue during sleep (this is indicative of a non-psychogenic cause). 
    • The impact on the person's quality of life. 
    • Weight loss — this may be indicative of an underlying cause or may be secondary to persistent hiccups. 
    • Symptoms that may indicate an underlying cause.
      • Pulmonary involvement may be indicated by dyspnoea, cough, sputum, and pleuritic chest pain.
      • Gastrointestinal involvement may be indicated by abdominal pain, heartburn, vomiting, diarrhoea, jaundice, dysphagia, and odynophagia.
      • Central nervous system involvement may be indicated by seizures, peripheral sensory, and motor symptoms.
      • Underlying malignancy may be indicated by fever, unexplained weight loss, and night sweats.
    • Past medical and medication history, paying particular attention to conditions that may affect the hiccup reflex arc — for more information, see the section on causes of persistent hiccups. 
  • Perform a physical examination:
    • Examine the neck for signs of trauma, nuchal rigidity, a goitre or neck cyst, cervical lymphadenopathy, or pharyngitis. 
    • Examine the auditory canals for evidence of a foreign body.
    • Examine the throat for evidence of inflammation of the pharyngeal mucosa.
    • Examine the respiratory system for signs of asthma, pneumonia, empyema, tuberculosis, or pleuritis. 
    • Examine the abdomen for signs of splenomegaly, hepatomegaly, abdominal aortic aneurysm. Acute abdomen may indicate cholecystitis, cholelithiasis, pancreatitis, appendicitis, intestinal obstruction, or rupture of a hollow viscus.
    • Carry out a neurological examination to detect evidence of stroke, meningismus, encephalitis, or a space-occupying lesion. 
  • Carry out baseline investigations, including:
    • Full blood count (abnormal findings include leukocytosis in inflammation or infection, and anaemia in malignancy or gastrointestinal haemorrhage). 
    • Urea and electrolytes (to exclude uraemia, hyponatraemia, hypokalaemia, and hypocalcaemia). 
  • Additional investigations that may be appropriate (some of which are performed in secondary care) include:
    • Abdominal CT — may reveal evidence of obstruction, perforation, inflammation, abscess, neoplasm, hepatosplenomegaly, or abdominal aortic aneurysm. 
    • Arterial blood gases — may reveal alkalosis. 
    • Chest radiograph — may reveal evidence of pulmonary disease, neoplasm, mediastinal lymphadenopathy, or cardiac abnormality. 
    • Electrocardiogram — may reveal evidence of ischaemia, pericarditis, or electrolyte disturbances.
    • Endoscopy of the upper GI tract — may reveal evidence of oesophagitis, oesophageal cancer, duodenal ulcer, or gastritis. 
    • Erythrocyte sedimentation rate or C-reactive protein level — elevated levels suggest inflammation, infection, or malignancy. 
    • Gamma-glutamyl transferase (gamma-GT) — may be elevated in biliary obstruction and chronic alcoholism. 
    • Head CT or MRI — may reveal evidence of a space-occupying lesion, inflammation, haemorrhage, or infarction. 
    • Liver function tests — AST and ALT may be elevated in hepatitis, and alkaline phosphatase may be elevated in biliary obstruction. 
    • Lumbar puncture — may reveal elevated protein, decreased glucose, leukocytes, bacteria, or xanthochromic liquor. 
    • Pulmonary function tests — may reveal an obstructive or restrictive pulmonary disorder. 
    • Serum amylase — may be elevated in pancreatitis. 
    • Toxicology screen — may reveal elevated blood alcohol, or positive drug screening for tetrahydrocannabinol (THC), amphetamines, cocaine, sedatives, or tricyclics. 

Basis for recommendation

These recommendations are based on the BMJ Best Practice guide Hiccups [BMJ Best Practice, 2026], the Scottish Palliative Care Guidelines Hiccups [HIS, 2021], and expert opinion in narrative reviews Hiccups: a non-systematic review [Leung 2020], and Hiccups in neurocritical care [Rajagopalan, 2021].

Management

Scenario: Management of hiccups

From birth onwards.

How should I manage a person with hiccups?

  • For people with hiccups of any duration:
    • Advise them to avoid any identified trigger factors (where possible).
    • Suggest the use of self-help remedies during a bout of hiccups, such as:
      • Breath holding. 
      • Breathing into a paper bag. 
      • Pulling on the tongue. 
      • Pulling the knees up to the chest. 
      • Sipping iced water. 
      • Sneezing. 
      • Swallowing a teaspoon of granulated sugar. 
      • Swallowing large amounts of water while closing the nose and ears. 
      • The Valsalva manoeuvre (a forced expiration against a closed glottis). 
  • For people with hiccups that have persisted for longer than 48 hours, or recurrent bouts of hiccups that persist for longer than an hour:
    • If history, physical examination, and/or baseline investigations have suggested a probable underlying cause, either treat in primary care if appropriate, or refer to an appropriate specialist, with urgency determined by clinical judgement. 
    • If no underlying cause is identified, consider carrying out any outstanding investigations (if applicable).
  • For people in whom an underlying cause cannot be identified, or whose hiccups persist after treatment of an identified underlying cause:
    • Consider physical manipulation techniques to interrupt the hiccup reflex arc, such as:
      • Stimulation of the nasopharynx with a finger, rubber catheter, or cotton-tipped applicator.
      • Lifting the uvula.
      • Inducing a gasp by smelling salts or other noxious agents. 
    • Consider specialist referral so that pharmacotherapy can be initiated. Drug treatments include:
      • Baclofen 5 mg every 8–12 hours to start, increased by 15 mg daily every 3 days to a maximum daily dose of 75 mg three times daily if required.
      • Chlorpromazine 10–25 mg (up to 25–50 mg three times daily) orally or intravenously. 
      • Metoclopramide 10 mg three to four times daily intravenously (off-label use). 
      • Other drug options include valproic acid, haloperidol, nifedipine, and gabapentin. 
    • Advise that acupuncture, hypnosis, and/or psychotherapy can be tried. 
    • If hiccups persist despite all of these measures and are associated with significant discomfort and morbidity, consider specialist referral for disruption of the phrenic nerve. 
  • Follow-up the person at an interval determined by clinical judgement. Advise them to report any signs of complications such as cardiac arrhythmias, insomnia, weight loss, and oesophagitis. 

Palliative care management of hiccups

In a palliative care situation, where hiccups are known to be a complication of cancer, specialist referral for pharmacotherapy or other measures to control hiccups may not be appropriate and it may be necessary to seek advice from a palliative care specialist.

  • Medications that may be appropriate include:  
    • An antiflatulent, such as peppermint water 10 ml twice daily.
    • Antacid medication containing simeticone.
    • A prokinetic, such as domperidone or metoclopramide 10 mg orally, every 8 hours.
    • A proton pump inhibitor, such as omeprazole to manage gastroesophageal reflux disease.
    • Dexamethasone 4 mg to 8 mg orally in the morning to reduce compression/irritation due to either hepatic, mediastinal or cerebral tumour.
      • This should be stopped if there is no benefit after one week.
  • Other options (after taking specialist advice) include:
    • Haloperidol 500 micrograms to 1 mg orally, every 8 hours. Maintenance dose is 1–3 mg at bedtime.
    • Baclofen 5 mg 20 mg orally, every 8 hours if required. Avoid abrupt withdrawal.
    • Levomepromazine 3 mg to 6 mg orally, at bedtime. Avoid if hypotensive. 
    • Nifedipine 5 mg to 20 mg orally, every 8 hours if required. Avoid if hypotensive.

[HIS, 2021]

Basis for recommendation

These recommendations are based on the BMJ Best Practice guide Hiccups [BMJ Best Practice, 2026], the Scottish Palliative Care Guideline Hiccups [HIS, 2021], and expert opinion in a narrative reviews Management of hiccups in palliative care patients [Jeon, 2018], and Hiccups in neurocritical care [Rajagopalan, 2021].

Using medications to treat hiccups
  • There is limited evidence to support treatment of hiccups and there are no formal guidelines available. Treatment recommendations are mostly based on observational reports and case series, and management is mainly directed at treating the underlying cause once it has been identified [Jeon, 2018; Rajagopalan, 2021; BMJ Best Practice, 2026]. 
    • One systematic review that aimed to identify literature on medication for intractable and persistent hiccups found while amitriptyline, baclofen, gabapentin, haloperidol, metoclopramide, midazolam, nifedipine, nimodipine, orphenadrine, and valproic acid were successful in treating hiccups, no specific recommendations could be made with the evidence currently available. The authors recommended that therapy selection should be specific to individual patients, their underlying comorbidities, aetiology of hiccups, and take into account the individual properties of the drugs [Polito, 2017]. 
    • Another systematic review that reviewed the evidence for baclofen in management of hiccups in adult palliative care patients, found that the overall quality of the evidence was low, and while baclofen was an option in the management of hiccups, it was difficult to make recommendations based on the body of evidence presented in this systematic review, as there was a lack of randomized controlled trials [Adam, 2020]. 
    • Similarly, the evidence base for recommending gabapentin was found to be limited in one literature review, with increasing confusion seen as a possible adverse effect [Got, 2021].
    • Expert opinion in a narrative review is that while several recent systematic reviews underscored the paucity of quality data to guide pharmacologic therapy, empiric proton pump inhibitor treatment should be considered in most people, metoclopramide or baclofen should be first-line treatments, and chlorpromazine a second or third line choice [Reichenbach, 2020].
Alternative therapies
  • The BMJ Best practice guide advises that in addition to conventional physical manipulation techniques and pharmacotherapy, alternative therapies, such as acupuncture, hypnosis, and psychotherapy can be tried for chronic hiccups [BMJ Best Practice, 2026]. However, CKS is aware there is a very limited evidence to support alternative therapies in hiccups due to limited randomized controlled trials, and the poor methodological quality of existing trials. 

Supporting evidence

This CKS topic is largely based on the BMJ Best Practice guide Hiccups [BMJ Best Practice, 2026], the Scottish Palliative Care Guideline Hiccups [HIS, 2021], and expert opinion in a narrative reviews Management of hiccups in palliative care patients [Jeon, 2018], Hiccups in neurocritical care [Rajagopalan, 2021], and Hiccups: a non-systematic review [Leung 2020]. The rationale for individual recommendations is outlined in the relevant basis for recommendation sections of the topic.

How this topic was developed

This section briefly describes the processes used in developing and updating this topic. Further details on the full process can be found in the About Us section and on the Clarity Informatics website.

Search strategy

A literature search was conducted for guidelines, systematic reviews and randomized controlled trials on primary care management of hiccups.

Search dates

January 2022 - April 2026

Key search terms

Various combinations of searches were carried out. The terms listed below are the core search terms that were used for Medline.

  • exp Hiccup/, hiccup$.tw, singlutus.tw

  • Exp Hiccups/

  • Singultus or hiccup$ or hiccough$ or HU or singultus or singlutus.kw,ti,ab.

Sources of guidelines

Sources of systematic reviews and meta-analyses

  • The Cochrane Library:
    • Systematic reviews
    • Protocols
    • Database of Abstracts of Reviews of Effects
  • Medline (with systematic review filter)
  • EMBASE (with systematic review filter)

Sources of health technology assessments and economic appraisals

Sources of randomized controlled trials

  • The Cochrane Library:
    • Central Register of Controlled Trials
  • Medline (with randomized controlled trial filter)
  • EMBASE (with randomized controlled trial filter)

Sources of evidence based reviews and evidence summaries

Sources of national policy

Patient experiences

Sources of medicines information

The following sources are used by CKS pharmacists and are not necessarily searched by CKS information specialists for all topics. Some of these resources are not freely available and require subscriptions to access content.

Stakeholder engagement

Our policy

The external review process is an essential part of CKS topic development. Consultation with a wide range of stakeholders provides quality assurance of the topic in terms of:

  • Clinical accuracy.
  • Consistency with other providers of clinical knowledge for primary care.
  • Accuracy of implementation of national guidance (in particular NICE guidelines).
  • Usability.

Principles of the consultation process

  • The process is inclusive and any individual may participate.
  • To participate, an individual must declare whether they have any competing interests or not. If they do not declare whether or not they have competing interests, their comments will not be considered.
  • Comments received after the deadline will be considered, but they may not be acted upon before the clinical topic is issued onto the website.
  • Comments are accepted in any format that is convenient to the reviewer, although an electronic format is encouraged.
  • External reviewers are not paid for commenting on the draft topics.
  • Discussion with an individual or an organization about the CKS response to their comments is only undertaken in exceptional circumstances (at the discretion of the Clinical Editor or Editorial Steering Group).
  • All reviewers are thanked and offered a letter acknowledging their contribution for the purposes of appraisal/revalidation.
  • All reviewers are invited to be acknowledged on the website. All reviewers are given the opportunity to feedback about the external review process, enabling improvements to be made where appropriate.

Stakeholders

  • Key stakeholders identified by the CKS team are invited to comment on draft CKS topics. Individuals and organizations can also register an interest to feedback on a specific topic, or topics in a particular clinical area, through the Getting involved section of the Clarity Informatics website.
  • Stakeholders identified from the following groups are invited to review draft topics:
    • Experts in the topic area.
    • Professional organizations and societies (for example, Royal Colleges).
    • Patient organizations, Clarity has established close links with groups such as Age UK and the Alzheimer’s Society specifically for their input into new topic development, review of current topic content and advice on relevant areas of expert knowledge.
    • Guideline development groups where the topic is an implementation of a guideline.
    • The British National Formulary team.
    • The editorial team that develop MeReC Publications.
  • Reviewers are provided with clear instructions about what to review, what comments are particularly helpful, how to submit comments, and declaring interests.

Patient engagement

Clarity Informatics has enlisted the support and involvement of patients and lay persons at all stages in the process of creating the content which include:

  • Topic selection
  • Scoping of topic
  • Selection of clinical scenarios
  • First draft internal review
  • Second draft internal review
  • External review
  • Final draft and pre-publication

Our lay and patient involvement includes membership on the editorial steering group, contacting expert patient groups, organizations and individuals.

Evidence exclusion criteria

Our policy

Scoping a literature search, and reviewing the evidence for CKS is a methodical and systematic process that is carried out by the lead clinical author for each topic. Relevant evidence is gathered in order that the clinical author can make fully informed decisions and recommendations. It is important to note that some evidence may be excluded for a variety of reasons. These reasons may be applied across all CKS topics or may be specific to a given topic.

Studies identified during literature searches are reviewed to identify the most appropriate information to author a CKS topic, ensuring any recommendations are based on the best evidence. We use the principles of the GRADE and PICOT approaches to assess the quality of published research. We use the principles of AGREE II to assess the quality of published guidelines.

Standard exclusions for scoping literature:

  • Animal studies
  • Original research is not written in English

Possible exclusions for reviewed literature:

  • Sample size too small or study underpowered
  • Bias evident or promotional literature
  • Population not relevant
  • Intervention/treatment not relevant
  • Outcomes not relevant
  • Outcomes have no clear evidence of clinical effectiveness
  • Setting not relevant
  • Not relevant to UK
  • Incorrect study type
  • Review article
  • Duplicate reference

Organizational, behavioural and financial barriers

Our policy

The CKS literature searches take into consideration the following concepts, which are discussed at the initial scoping of the topic.

  • Feasibility
    • Studies are selected depending on whether the intervention under investigation is available in the NHS and can be practically and safely undertaken in primary care.
  • Organizational and Financial Impact Analysis
  • Studies are selected and evaluated on whether the intervention under investigations may have an impact on local clinical service provision or national impact on cost for the NHS. The principles of clinical budget impact analysis are adhered to, evaluated and recorded by the author. The following factors are considered when making this assessment and analysis.
    • Eligible population
    • Current interventions
    • Likely uptake of new intervention or recommendation
    • Cost of the current or new intervention mix
    • Impact on other costs
    • Condition-related costs
    • In-direct costs and service impacts
    • Time dependencies
  • Cost-effectiveness or cost-benefit analysis studies are identified where available. 

We also evaluate and include evidence from NICE accredited sources which provide economic evaluations of recommendations, such as NICE guidelines. When a recommended action may not be possible because of resource constraints, this is explicitly indicated to healthcare professionals by the wording of the CKS recommendation.

Declarations of interest

Our policy

Clarity Informatics requests that all those involved in the writing and reviewing of topics, and those involved in the external review process to declare any competing interests. Signed copies are securely held by Clarity Informatics and are available on request with the permission of the individual. A copy of the declaration of interest form which participants are asked to complete annually is also available on request. A brief outline of the declarations of interest policy is described here and full details of the policy is available on the Clarity Informatics website. Declarations of interests of the authors are not routinely published, however competing interests of all those involved in the topic update or development are listed below. Competing interests include:

  • Personal financial interests
  • Personal family interest
  • Personal non-financial interest
  • Non-personal financial gain or benefit

Although particular attention is given to interests that could result in financial gains or losses for the individual, competing interests may also arise from academic competition or for political, personal, religious, and reputational reasons. An individual is not obliged to seek out knowledge of work done for, or on behalf of, the healthcare industry within the departments for which they are responsible if they would not normally expect to be informed.

Who should declare competing interests?

Any individual (or organization) involved in developing, reviewing, or commenting on clinical content, particularly the recommendations should declare competing interests. This includes the authoring team members, expert advisers, external reviewers of draft topics, individuals providing feedback on published topics, and Editorial Steering Group members. Declarations of interest are completed annually for authoring team and editorial steering group members, and are completed at the start of the topic update and development process for external stakeholders.

Competing interests declared for this topic:

None.

References

  • Adam, E. (2020) A systematic review of the effectiveness of oral baclofen in the management of hiccups in adult palliative care patients. Journal of Pain and Palliative Care Pharmacotherapy 34(1), 43-54. [Abstract]
  • BMJ Best Practice (2026) Hiccups. BMJ Publishing Group. https://bestpractice.bmj.com
  • Got, T., Vivas, L., Fan, C. and MacNeill, H. (2021) Treatment of hiccups in stroke rehabilitation with gabapentin: A case series and focused clinical review. Topics in Stroke Rehabilitation 28(6), 475-480. [Abstract]
  • Hendrix, K., Wilson, D., Kievman, M. J. and Jatoi, A. Perspectives on the medical, quality of life, and economic consequences of hiccups. Current Oncology Reports 21(12). [Abstract]
  • HIS (2021) Scottish Palliative Care Guidelines, Symptoms management: Hiccups. Healthcare Improvement Scotland. https://www.rightdecisions.scot.nhs.uk [Free Full-text]
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