# Retching > Mediated Wiki article. Canonical URL: https://mediated.wiki/source/Retching > Markdown URL: https://mediated.wiki/source/Retching.md > Source: https://en.wikipedia.org/wiki/Retching > Source revision: 1319311177 > License: Creative Commons Attribution-ShareAlike 4.0 International (https://creativecommons.org/licenses/by-sa/4.0/) {{Short description|Reverse movement of the stomach and esophagus without vomiting}} {{Infobox medical condition (new) | name = Retching | synonyms = | image = | caption = | field = [Gastroenterology](/source/Gastroenterology) | pronounce = | symptoms = | complications = | onset = | duration = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }} '''Retching''' (also known as '''dry heaving''') is the reverse movement ([retroperistalsis](/source/retroperistalsis)) of the [stomach](/source/stomach) and [esophagus](/source/esophagus) without [vomiting](/source/vomiting).{{cite web |url=http://www.emedicinehealth.com/vomiting_and_nausea/article_em.html |title=Vomiting and Nausea |work=[eMedicine](/source/eMedicine) |date=February 12, 2012 |access-date=February 12, 2012 |archive-date=December 1, 2017 |archive-url=https://web.archive.org/web/20171201131617/https://www.emedicinehealth.com/vomiting_and_nausea/article_em.html |url-status=dead }} It can be caused by bad smells or choking, or by withdrawal from certain medications, or after vomiting has completed. Retching can also occur as a result of an emotional response or from [stress](/source/stress_(biology)), which produces the same physical reaction. The function is thought to be mixing [gastric content](/source/gastric_content)s with intestinal refluxate in order to buffer the former and give it momentum in preparation of vomiting. Treatments include medication and correction of the [fluid](/source/fluid_balance) and [electrolyte balance](/source/Electrolyte_disturbance). ==Physiology== The retching phase is characterized by a series of violent spasmodic [abdomino](/source/abdominal)-[thoracic](/source/thoracic) contractions with the [glottis](/source/glottis) closed. During this time, the inspiratory (inhalatory) movements of the chest wall and [diaphragm](/source/Thoracic_diaphragm) are opposed by the expiratory contractions of the abdominal musculature. At the same time, movements of the [stomach](/source/stomach) and its contents take place. Whereas a patient will complain of disagreeable sensations during [nausea](/source/nausea), speech is not possible during retching. The characteristic movements furnish a ready diagnostic sign of the retching phase. Schindler (1937){{cite book|last=Schindler|first=R|title=Gastroscopy|year=1937|publisher=University of Chicago Press|location=Chicago|pages=145}} studied retching on two occasions during [gastroscopy](/source/gastroscopy) and noted that longitudinal folds appeared in the previously smooth [antrum](/source/pyloric_antrum), thickened quickly, came together and completely closed the antrum.{{cite book|last=Keet|first=AD|title=The Pyloric Sphincteric Cylinder in Health and Disease|year=1998|publisher=PLiG|pages=122|url=http://med.plig.org/26/122.html#|chapter=Nausea, Retching, and Vomiting}} Retching involves a deep inspiration against a closed [glottis](/source/glottis). This, along with contraction of the abdomen, leads to a pressure difference between the abdominal and thoracic cavities. As a result, the stomach and gastric contents are displaced upwards toward the thoracic cavity.{{cite book | last = Berne | first = Robert M.|author2=Matthew N. Levy | title = Physiology| publisher = Elsevier Mosby| year = 2004| page = 557 | isbn =0-323-03390-3 }} Retching comprises a rhythmically alternating (about once per second) elevation and descension of the entire {{not a typo|pharyngolaryngo-esophago-gastric}} apparatus in synchrony with the movement of the diaphragm. The function of retching may be to mix gastric contents with intestinal refluxate to buffer gastric contents before gastroesophageal reflux and to impart a momentum to the gastric contents before vomiting. Airway protection during retching is accomplished by glottal closure during retches and constriction of the [upper esophageal sphincter](/source/Esophageal_sphincter%2C_upper) between retches.{{cite journal|last=Lang|first=IM|author2=Dana, N |author3=Medda, BK |author4=Shaker, R |title=Mechanisms of airway protection during retching, vomiting, and swallowing.|journal=American Journal of Physiology. Gastrointestinal and Liver Physiology|date=September 2002|volume=283|issue=3|pages=G529-36|doi=10.1152/ajpgi.00062.2002|pmid=12181164}} ==Versus vomiting== Vomiting (the expulsion of gastric contents) is usually preceded by retching, but retching and vomiting can occur separately{{cite journal|last=Andrews|first=PL |author2=Davis, CJ |author3=Bingham, S |author4=Davidson, HI |author5=Hawthorn, J |author6=Maskell, L|title=The abdominal visceral innervation and the emetic reflex: pathways, pharmacology, and plasticity.|journal=Canadian Journal of Physiology and Pharmacology|date=February 1990|volume=68|issue=2|pages=325–45|pmid=2178756|doi=10.1139/y90-047}} and involve different sets of muscles.{{cite journal|last=Grelot|first=L|author2=Miller, AD |title=Vomiting - Its Ins and Outs|journal=News in Physiological Sciences|year=1994|volume=9|pages=142–147|url=http://physiologyonline.physiology.org/content/9/3/142.abstract#cited-by|issue=3}} During a retch, [thoracic pressure](/source/thoracic_pressure) is ''decreased'' and abdominal pressure is ''increased'', which may serve to position gastric contents and overcome esophageal resistance. Conversely, a vomit occurs with ''increased'' thoracic and abdominal pressure. Retches and vomits are commonly lumped together in behavioral analyses and consequently the neural controls for these processes are not well delineated.{{cite journal |last1=Horn |first1=Charles |date=11 October 2007 |pmc=2274963 |id=nihmsid: NIHMS42868 |title=Why is the neurobiology of nausea and vomiting so important? |journal=Appetite |volume=50 |issue=2–3 |pages=430–434 |doi=10.1016/j.appet.2007.09.015 |pmid=17996982}} ==Treatments== The treatments for significant retching include correction of fluid and electrolyte balance, nutritional support and medications like [phenothiazines](/source/phenothiazines) (such as [Compazine](/source/Compazine) and [Phenergan](/source/Phenergan)), [5-HT3 antagonist](/source/5-HT3_antagonist) (such as [Zofran](/source/Zofran)), [dopamine receptor antagonists](/source/Dopamine_antagonist) (such as [Reglan](/source/Reglan)), [antihistamines](/source/antihistamines) ([Antivert](/source/Antivert), [Dramamine](/source/Dramamine), [Benadryl](/source/Benadryl)) and [anticholinergics](/source/anticholinergics) ([scopolamine](/source/scopolamine)). Alternative approaches are also available. The best-studied alternative therapy is perhaps the use of [acupressure](/source/acupressure) for pregnancy-related nausea and vomiting.{{Citation needed|date=March 2020}} Wristbands with acupressure buttons are commercially available. An implanted device with attached electrodes into the gastric wall can be an option for patients with refractory nausea and vomiting.{{cite web|last=Porter|first=Ryan F.|title=Nausea and Vomiting|url=http://patients.gi.org/topics/nausea-and-vomiting|work=Patient Education & Resource Center|publisher=American College of Gastroenterology|author2=Gyawali, C. Prakash }} ==See also== * [Pharyngeal reflex](/source/Pharyngeal_reflex), the gag reflex *[Regurgitation (digestion)](/source/Regurgitation_(digestion)) ==References== {{reflist}} Category:Reflexes Category:Digestive disease symptoms Category:Vomiting --- Adapted from the Wikipedia article [Retching](https://en.wikipedia.org/wiki/Retching) by Wikipedia contributors ([contributor history](https://en.wikipedia.org/wiki/Retching?action=history)). Available under [Creative Commons Attribution-ShareAlike 4.0 International](https://creativecommons.org/licenses/by-sa/4.0/). Changes may have been made.