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Dr. Andrew Rynne

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What causes excessive gurgling in the upper abdomen?

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General & Family Physician
Practicing since : 2012
Answered : 3614 Questions
What could cause excessive gurgling in the upper abdomen?
Tue, 12 Aug 2014 in Digestion and Bowels
Answered by Dr. Shafi Ullah Khan 35 minutes later

Excessive gurgling is either due to Indigestion , Partial Obstruction or Hyper motility ( Secondary to Hyperthyroidism ) But among these Indigestion is the most common .
Above answer was peer-reviewed by
Follow-up: What causes excessive gurgling in the upper abdomen? 1 hour later
What if its accompanied by violet hiccups?
Answered by Dr. Shafi Ullah Khan 2 hours later
Brief Answer:
indigestion reflux need management

Detailed Answer:

Thank you for asking
Excessive gurgling accompanied by violent hiccups are most likely an indigestion and gastric reflux issue.
It needs diet and lifestyle modifications.
following things help
Losing weight (if overweight)
Avoiding alcohol, chocolate, citrus juice, and tomato-based products
Avoiding peppermint, coffee, and possibly the onion family
Eating small, frequent meals rather than large meals
Waiting 3 hours after a meal to lie down
Refraining from ingesting food (except liquids) within 3 hours of bedtime
Elevating the head of the bed 8 inches
Avoiding bending or stooping positions.get some antispasmodic like phloroglucinol and some antacids like proton pump inhibitors for the relief meanwhile.

Now the hiccups.

Brief episodes of hiccups are a common part of life; however, prolonged attacks are a more serious phenomenon and have been associated with significant morbidity and even death.
To know what is causing hiccups following issues need to be addressed as they are the major likely reasons for hiccups.
Surgical history
Comprehensive drug history
Indicators of psychogenic origin
Arrhythmia-induced syncope
Gastroesophageal reflux
Weight loss
Emotional distress
Alcoholism and acute alcohol ingestion

Then comes the role of examination of body parts thoroughly for example
Head – Foreign body or aberrant hair adjacent to tympanic membrane; glaucoma
Mouth - Pharyngitis
Neck – Inflammation; mass lesions; goiter; voice abnormalities; stiffness
Chest – Tumors; pneumonia; asthma
Cardiovascular system – Arrhythmias; myocardial infarction (MI); pericarditis; unequal pulses
Abdomen – Gastric atony; organomegaly; subphrenic abscess; cholecystitis; appendicitis; abdominal aortic aneurysm (AAA); pancreatitis; peritonitis
Rectum – Mass lesions
Nervous system – Focal lesions; disordered higher mental function; indications of multiple sclerosis

Then comes the role of Workup and labs and radiology imaging ot help the cause
Electrolytes - Hyponatremia, hypokalemia, hypocalcemia, and hyperglycemia
Renal function tests - Uremia
Liver function tests - Hepatitis
Amylase and lipase levels - Pancreatitis
White blood cell (WBC) count
Urine, sputum, or cerebrospinal fluid (CSF) - Infection
Imaging modalities that may be helpful in the workup include the following:
Chest radiography
Fluoroscopy of diaphragmatic movement
Computed tomography (CT) of the head, thorax, and abdomen
Magnetic resonance imaging (MRI)
Other studies that may be helpful include the following:

Nerve conduction studies
Endoscopy or bronchoscopy
Esophageal acid perfusion test

Once the reason of Hiccups is diagnosed then the management is easy. It is divided in to two groups.
1)Pharmacological and 2) Non pharmacological.
Pharmacologic therapies include the following:

Chlorpromazine (drug of choice)
Valproic acid
Other agents reported to be beneficial are as follows:

Muscle relaxants (not benzodiazepines)
Analgesics (eg, orphenadrine, amitriptyline, chloral hydrate, and morphine)
Stimulants (eg, ephedrine, methylphenidate, amphetamine, and nikethamide)
Miscellaneous agents (eg, edrophonium, dexamethasone, amantadine, and nifedipine)
Nonpharmacologic therapies include the following:
a)Techniques affecting components of the hiccup reflex - Stimulation of the nasopharynx; C3-5 dermatome stimulation; direct pharyngeal stimulation; direct uvular stimulation; removal of gastric contents
b)Techniques leading to vagal stimulation - Iced gastric lavage; Valsalva manoeuvre; carotid sinus massage; digital rectal massage; digital ocular globe pressure
c)Techniques interfering with normal respiratory function - Breath holding; hyperventilation; gasping; breathing into a paper bag; pulling the knees up to the chest and leaning forward; continuous positive airway pressure; rebreathing 5% carbon dioxide
Mental distraction
Behavioral conditioning
Phrenic nerve or diaphragmatic pacing
Surgical intervention (typically a last resort) may include the following:

Phrenic nerve ablation (unilateral or bilateral as appropriate)

Microvascular decompression of the vagus nerve if need be.

I hope it helps. Seek a gastroenterologist for further management and try non pharmacological manoeuvres meanwhile for the relief.

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