Retching (also known as dry heaving) is the reverse movement (

retroperistalsis Retroperistalsis is the reverse of the involuntary smooth muscle contractions of peristalsis. It usually occurs as a precursor to vomiting. Local irritation of the stomach, such as bacteria or food poisoning, activates the emetic center of the ...

) of the

stomach The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital organ in the digestive system. The stomach i ...

and

esophagus The esophagus (American English) or oesophagus (British English; both ), non-technically known also as the food pipe or gullet, is an organ in vertebrates through which food passes, aided by peristaltic contractions, from the pharynx to t ...

without

vomiting Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenter ...

. 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 Stress may refer to: Science and medicine * Stress (biology), an organism's response to a stressor such as an environmental condition * Stress (linguistics), relative emphasis or prominence given to a syllable in a word, or to a word in a phrase ...

, which produces the same physical reaction. The function is thought to be mixing gastric contents 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 In physics, a fluid is a liquid, gas, or other material that continuously deforms (''flows'') under an applied shear stress, or external force. They have zero shear modulus, or, in simpler terms, are substances which cannot resist any shear ...

and electrolyte balance.

Physiology

The retching phase is characterized by a series of violent spasmodic abdomino-

thoracic The thorax or chest is a part of the anatomy of humans, mammals, and other tetrapod animals located between the neck and the abdomen. In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main divisions of the crea ...

contractions with the

glottis The glottis is the opening between the vocal folds (the rima glottidis). The glottis is crucial in producing vowels and voiced consonants. Etymology From Ancient Greek ''γλωττίς'' (glōttís), derived from ''γλῶττα'' (glôtta), v ...

closed. During this time, the inspiratory (inhalatory) movements of the chest wall and

diaphragm Diaphragm may refer to: Anatomy * Thoracic diaphragm, a thin sheet of muscle between the thorax and the abdomen * Pelvic diaphragm or pelvic floor, a pelvic structure * Urogenital diaphragm or triangular ligament, a pelvic structure Other * Diap ...

are opposed by the expiratory contractions of the abdominal musculature. At the same time, movements of the

and its contents take place. Whereas a patient will complain of disagreeable sensations during

nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of th ...

, speech is not possible during retching. The characteristic movements furnish a ready diagnostic sign of the retching phase. Schindler (1937) studied retching on two occasions during

gastroscopy Esophagogastroduodenoscopy (EGD) or oesophagogastroduodenoscopy (OGD), also called by various other names, is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract down to the duodenum. It is considered ...

and noted that longitudinal folds appeared in the previously smooth

antrum ''This is a disambiguation page for the biological term. For the 2018 horror movie, see Antrum (film)'' In biology, antrum is a general term for a cavity or chamber, which may have specific meaning in reference to certain organs or sites in the bod ...

, thickened quickly, came together and completely closed the antrum. Retching involves a deep inspiration against a closed

. 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. Retching comprises a rhythmically alternating (about once per second) elevation and descension of the entire 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 The esophagus (American English) or oesophagus (British English; both ), non-technically known also as the food pipe or gullet, is an organ in vertebrates through which food passes, aided by peristaltic contractions, from the pharynx to the ...

between retches.

Versus vomiting

Vomiting (the expulsion of gastric contents) is usually preceded by retching, but retching and vomiting can occur separately and involve different sets of muscles. During a retch, 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.

Treatments

The treatments for significant retching include correction of fluid and electrolyte balance, nutritional support and medications like

phenothiazines Phenothiazine, abbreviated PTZ, is an organic compound that has the formula S(C6H4)2NH and is related to the thiazine-class of heterocyclic compounds. Derivatives of phenothiazine are highly bioactive and have widespread use and rich history. Th ...

(such as

Compazine Prochlorperazine, formerly sold under the brand name Compazine among others, is a medication used to treat nausea, migraines, schizophrenia, psychosis and anxiety. It is a less preferred medication for anxiety. It may be taken by mouth, rectally ...

and

Phenergan Promethazine is a first-generation antihistamine, antipsychotic, sedative, and antiemetic used to treat allergies, insomnia, and nausea. It may also help with some symptoms associated with the common cold and may also be used for sedating peop ...

5-HT3 antagonist The 5-HT3 antagonists, informally known as "setrons", are a class of drugs that act as receptor antagonists at the 5-HT3 receptor, a subtype of serotonin receptor found in terminals of the vagus nerve and in certain areas of the brain. With th ...

(such as

Zofran Ondansetron, sold under the brand name Zofran among others, is a medication used to prevent nausea and vomiting caused by cancer chemotherapy, radiation therapy, or surgery. It is also effective for treating gastroenteritis. It can be given by m ...

), dopamine receptor antagonists (such as

Reglan Metoclopramide is a medication used for stomach and esophageal problems. It is commonly used to treat and prevent nausea and vomiting, to help with emptying of the stomach in people with delayed stomach emptying, and to help with gastroesoph ...

antihistamines Antihistamines are drugs which treat allergic rhinitis, common cold, influenza, and other allergies. Typically, people take antihistamines as an inexpensive, generic (not patented) drug that can be bought without a prescription and provides re ...

(

Antivert Meclizine, sold under the brand name Bonine, among others, is an antihistamine used to treat motion sickness and dizziness (vertigo). It is taken by mouth. Effects generally begin in an hour and last for up to a day. Common side effects incl ...

, and

Dramamine Dimenhydrinate, sold under the brand name Dramamine, among others, is an over-the-counter drug used to treat motion sickness and nausea. Dimenhydrinate is a theoclate salt composed of diphenhydramine, an ethanolamine derivative, and 8-chloro ...

Benadryl Benadryl is a brand of various antihistamine medications used to stop allergies, whose content varies in different countries, but which includes some combination of diphenhydramine, acrivastine, and/or cetirizine. It is sold by Johnson & Johnso ...

) and

anticholinergics Anticholinergics (anticholinergic agents) are substances that block the action of the neurotransmitter called acetylcholine (ACh) at synapses in the central and peripheral nervous system. These agents inhibit the parasympathetic nervous sys ...

(

Scopolamine Scopolamine, also known as hyoscine, or Devil's Breath, is a natural or synthetically produced tropane alkaloid and anticholinergic drug that is formally used as a medication for treating motion sickness and postoperative nausea and vomi ...

). Alternative approaches are also available. The best-studied alternative therapy is perhaps the use of acupressure for pregnancy-related nausea and vomiting. 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.

References

{{reflist Reflexes Digestive disease symptoms Vomiting

Physiology

Versus vomiting

Treatments

See also

References