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Evidence suggests that an imbalance between tonic and phasic dopamine signaling, characterized by reduced baseline activity but exaggerated transient reward responses, leads to abnormally strong reward reinforcement effects and manifests clinically as impulsivity and distractibility (144)

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In conclusion, while anesthesia and pain medications may play a role, the primary causes of hiccups after gastric bypass surgery are swallowing air, dehydration, and eating habits

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