Intractable hiccups as initial manifestation of achalasia: a case report.

BACKGROUND

Intractable hiccups pose a clinical challenge due to their diverse etiologies and lack of standard treatment. While associated with esophageal conditions, hiccups rarely occur in achalasia.

CASE REPORT: A 65-year-old man presented with intractable hiccups, heartburn, and regurgitation for 7 years and progressive dysphagia and weight loss for 2 years. He was unrelieved by Nissen fundoplication for suspected gastroesophageal reflux disease (GERD), performed with no previous assessment of esophageal motility. Two years later, high-resolution impedance manometry (HRIM) revealed type I achalasia. The patient underwent a Heller myotomy, with revision of the fundoplication, resulting in complete resolution of dysphagia, regurgitation, and hiccups.

CONCLUSION

This case underscores the rare association of hiccups with achalasia, as well as the importance of manometric assessment in cases of atypical symptoms and dysphagia, and the efficacy of surgical intervention in refractory cases.