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Hematemesis: Causes and Treatments for Vomiting Blood

Sometimes you might spit up bloody material from your lungs, too. This is usually foamy and bright red and happens after a lot of coughing. It’s called hemoptysis and is commonly confused with vomiting blood.

What Is Hematemesis (Vomiting Blood)?

Hematemesis is a serious condition that causes you to throw up blood. It’s more than just a fleck of blood in your spit, though; vomiting blood is a sign that you’re bleeding in your digestive system, and you should get medical attention right away.

What Causes Hematemesis?

Hematemesis is a sign of bleeding in your upper digestive tract. This includes the first part of your intestine, your stomach, or your esophagus. Your esophagus is the tube that connects your mouth to your stomach.

Some common hematemesis causes include:

Stomach ulcers. Known as a peptic ulcer, this condition is a painful, open sore in your stomach lining. You can also get these sores in the first part of your intestine; these are called duodenal ulcers. These sores can damage an artery, causing you to vomit blood.

Esophageal varices. Esophageal varices are swollen vessels in the tube from your mouth to your stomach. These occur when scarring or clots in your liver block normal blood flow. The blood will redirect to these smaller vessels, which aren’t meant to carry a lot of blood. When they become too swollen, they can leak blood or burst and cause life-threatening bleeding.

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Gastroesophageal reflux disease. Also known as GERD, this condition happens when stomach acid backwashes into your esophagus and causes inflammation. Severe cases can irritate your lining and cause bleeding.

Mallory-Weiss tear. This is a bleeding tear in your esophagus lining that occurs after violent and prolonged coughing or vomiting. It’s often linked to heavy alcohol drinking.

Less Common Causes of Vomiting Blood

There are other less common hematemesis causes, too. These can include:

  • Radiation exposure
  • Stomach cancer
  • Esophagus cancer
  • Swallowing a poison
  • Hemorrhagic fever, where an infectious disease causes severe illness and internal bleeding
  • A blood condition like anemia or hemophilia

What Are Hematemesis Symptoms?

The main symptom of hematemesis is blood in your vomit. The blood and vomit can be:

  • Bright red blood
  • Brown
  • Black
  • Like coffee grounds

You might also have blood in your stool, which looks like sticky, black tar.

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When you lose a lot of blood, your organs don’t get enough oxygen and you may go into shock. If you are vomiting blood and also have the following symptoms, call 911:

  • Dizziness
  • Cool, clammy skin
  • Pale skin
  • Blue lips or fingernails if you have light skin
  • Gray lips or fingernails if you have dark skin
  • Fast and shallow breathing
  • Weakness
  • Tiredness
  • Fast pulse

How Is Hematemesis Diagnosed?

If you think you’re vomiting blood, you should go to a hospital right away. If you can, bring a small sample of it with you. Your doctor will need details about what the vomit looks like.

They will examine you and ask details about how you’re feeling. You might need some tests to confirm where and why you’re bleeding. These can include:

  • Blood tests to look for infections or clotting problems
  • X-ray scans
  • Endoscopy, where a tube with a camera is placed into your esophagus to get images
  • Nuclear medicine scan, which uses radiation to take images of how your organs

Since vomiting blood is a medical emergency, if you have symptoms of shock and trouble breathing, your doctor will give emergency treatment first.

What Is the Treatment for Hematemesis?

True hematemesis is a medical emergency and can’t be treated at home. Your doctor will need to find the cause of your bleeding and stop it, then treat any underlying conditions. If you have only a little blood loss, they might give you medications and some fluids.

If you have a lot of blood loss, you might need:

  • Blood transfusion
  • Intravenous, or IV, fluids
  • Oxygen and breathing assistance
  • Blood-pressure medications

Once you’re stable, your doctor will treat the cause. Treatment can include antacid medications, antibiotics, embolization to block a blood vessel, and other treatments.

Is a Little Blood in Vomit Normal?

It’s common to have blood in your spit after brushing and flossing your teeth. You might also vomit swallowed blood after a nosebleed, but this isn’t hematemesis.

Sometimes you might spit up bloody material from your lungs, too. This is usually foamy and bright red and happens after a lot of coughing. It’s called hemoptysis and is commonly confused with vomiting blood.

If you’re spewing vomit from your mouth with bright red blood but you haven’t had a nosebleed, or if it’s black or looks like coffee grounds, see a doctor. If it looks like coffee grounds, it means blood has been there for a few hours.

Show Sources

Cleveland Clinic: “Vomiting Blood.”

Mayo Clinic: “Esophageal varices,” “Peptic ulcer.” “Shock: First aid,” “Vomiting blood.”

Medical University of South Carolina MUSC Health: “Hematemesis.”

National Health Service: “Vomiting blood (haematemesis).”

Wilson, D. Clinical Methods: The History, Physical, and Laboratory Examinations, “Hematemesis, Melena, and Hematochezia,” Butterworths, 1990.

Hematemesis: Causes and Treatments for Vomiting Blood

Vomiting blood (hematemesis) is the regurgitation of stomach contents mixed with blood, or the regurgitation of blood only. Blood in vomit generally comes from an upper gastrointestinal (GI) source, such as your stomach.

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In some cases, minor causes may trigger vomiting blood, such as swallowing blood from a mouth injury or a nosebleed. These situations will likely not cause any long-term harm.

Vomiting blood may also be caused by more serious conditions that can be a medical emergency, such as:

  • internal injuries
  • organ bleeding
  • organ rupture

What to do if you’re vomiting blood

Vomiting blood is considered a medical emergency. You should always contact a medical professional if you notice blood in your vomit. It can be hard to determine the cause and severity of bleeding without a medical opinion.

You may be able to call your doctor if there’s an obvious, benign cause for blood in your vomit, such as having a recent nosebleed or oral surgery. Otherwise, call 911 or go to the emergency room (ER) immediately.

The color of vomited blood may help indicate to your doctor the source and severity of the bleeding. Regurgitated blood may appear:

  • bright red
  • as red streaks mixed with food
  • brown, which often resembles coffee grounds

Bright red blood often indicates an acute bleeding episode in your esophagus or stomach. It may represent a fast-bleeding source.

Darker-colored blood means the blood has been in your GI tract for a few hours. It usually represents a slower and steadier source of bleeding.

If possible, take a picture of the vomit with blood to show your doctor.

hematemesis colors

Call your doctor immediately or go to the ER right away if you vomit any amount of blood, especially if it follows an injury. Blood in vomit can be due to any number of causes, from mild to life threatening. It can be difficult to tell the source of the bleeding without a medical exam.

Vomiting blood caused by excessive bleeding can cause shock due to internal GI bleeding. Common symptoms of shock include:

  • fast, shallow breathing
  • rapid heartbeat
  • low urine output
  • pale skin
  • cold or clammy skin
  • confusion
  • fainting
  • dizziness upon standing
  • blurred vision

If not treated immediately, shock can lead to irreversible organ dysfunction, multi-organ failure, and death.

If you experience any symptoms of shock, have someone take you to the ER or call 911.

Some people vomit blood after drinking alcoholic beverages. You may be more likely to throw up after drinking alcohol if you:

  • drink on an empty stomach
  • smoke cigarettes
  • take an antidepressant or antipsychotic medication

Alcohol use disorder can also lead to more serious chronic conditions that cause vomiting blood, such as alcohol-related liver disease and esophageal varices. Symptoms such as blood in vomit usually do not appear until the liver has been severely damaged.

There are many causes of vomiting blood that range in severity from minor to major. They are normally the result of an injury, illness, or medication use.

Common causes of vomiting blood include:

  • swallowing blood following a nosebleed or oral surgery
  • a tear in the esophagus due to excessive coughing or vomiting
  • a bleeding ulcer
  • gastritis (stomach inflammation)
  • severe gastroesophageal reflux disease (GERD)
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Less common and more serious causes include:

  • esophageal varices
  • alcoholic hepatitis
  • fatty liver disease
  • cirrhosis
  • long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs)
  • hemophilia
  • anemia
  • esophageal cancer
  • stomach cancer

All instances of vomiting blood should be reported to your doctor.

To diagnose the cause for blood in your vomit, your doctor will begin by asking questions about your symptoms and whether or not you were recently injured.

Your doctor will likely perform an upper endoscopy to look inside your GI tract while you’re sedated.

They will place a small, flexible tube called an endoscope into your mouth and down into your stomach and small intestine. A fiber optic camera in the tube allows your doctor to see the contents of your stomach and examine you internally for any sources of bleeding.

Your doctor may also order a blood test to check your complete blood count. This helps to assess the amount of blood lost.

If your doctor suspects bleeding is due to another condition such as cancer, they may order imaging tests to look inside your body. These scans reveal atypical characteristics in your body, such as ruptured organs or atypical growths, and may include:

  • CT scans
  • ultrasounds
  • X-rays
  • MRI scans
  • positron emission tomography (PET) scans

Your doctor my perform a biopsy of suspicious tissue as well as other tests based on the condition they suspect may be causing you to vomit blood.

Depending on the cause, vomiting blood may cause additional health complications.

Anemia is one complication of excessive bleeding. It’s a deficiency of healthy red blood cells. It occurs particularly when blood loss is rapid and sudden.

However, people with conditions that progress slowly, such as gastritis, or people with chronic NSAID use may develop anemia over several weeks to months. In this case, anemia may remain without symptoms until their hemoglobin, or blood count, is very low.

Vomiting blood can also lead to shock, which can be fatal and requires immediate medical attention.

Depending on the amount of blood lost, you may need a blood transfusion. A blood transfusion replaces your lost blood with donor blood. The blood is sent into your vein through an intravenous (IV) line. You might also require fluid through an IV to rehydrate your body.

Depending on the cause, your doctor may prescribe medication to stop the vomiting or to decrease stomach acid. If you have an ulcer, your doctor will prescribe medications to treat it.

In more severe cases of upper GI bleeding, your doctor may refer you to a gastroenterologist.

The gastroenterologist may perform an upper endoscopy to diagnose and treat the source of bleeding. In severe cases, such as stomach or bowel perforation, surgery may be needed.

Last medically reviewed on December 2, 2021

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