Hiccups (singultus) are most often a transient phenomenon that resolves without medical therapy. Intractable hiccups can be an indication of a serious underlying disease process and should be investigated. To demonstrate the evaluation of intractable singultus, we describe a patient who had unsuccessful outpatient therapy for persistent hiccups and who was subsequently found to have gastroesophageal reflux (GER). Efforts to determine the cause of the hiccups were negative except for endoscopically proven GER. On follow-up visits, antisingultus medications were withdrawn without return of hiccups, and repeat endoscopy showed substantial healing of the esophagitis. We conclude that GER may be underestimated as a cause of hiccups.