A range of medical conditions can cause people to vomit blood. This is a medical emergency.

Vomiting blood is also known as hematemesis.

Conditions that can cause hematemesis can range from a simple nosebleed to a severe bleed in the gut.

Hematemesis does not refer to streaks of blood in the vomit. It relates to vomit that contains significant amounts of bright red blood or has a black, gritty appearance similar to coffee grounds. The coffee ground appearance occurs when blood has been sitting in the stomach for an extended period.

Vomiting blood is a medical emergency. Seek treatment immediately, whatever the cause.

This article explores some of the possible causes of hematemesis and how to identify and treat them.

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Blood in the vomit can be a sign of a major health problem.

Several health problems can cause a person to vomit blood, such as:

  • stomach ulcers
  • vigorous vomiting
  • tears, irritation, or tissue loss in the lining of the stomach
  • enlargement of veins in the food pipe or gut
  • tumors and lesions of the stomach or esophagus
  • radioactive damage to the upper gut
  • infections, such as hepatitis or Helicobacter pylori (H. pylori) infection
  • use of certain medications, such as aspirin, NSAIDs, or blood thinners
  • poison ingestion
  • pregnancy, as a complication of morning sickness and regular vomiting

Specific medical conditions that can lead to hematemesis include:

  • gastroenteritis
  • gastroesophageal reflux disease (GERD)
  • blood vessel disorders in the gut
  • inflammation of the food pipe, gut, or pancreas
  • pancreatic cancer
  • certain liver conditions, such as acute liver failure and cirrhosis
  • Dieulafoy's lesion, a condition where an artery sticks out through the stomach wall
  • Mallory-Weiss tears, tears in the food pipe caused by the raised pressure of vomiting or coughing
  • portal hypertension, a condition in which high blood pressure occurs in the portal vein
  • anomalies in the blood, such as a low platelet count, hemophilia, anemia, or leukemia

A range of other conditions can cause heavy blood flow in the vomit of infants and young children, including:

  • congenital anomalies
  • blood-clotting disorders
  • vitamin K deficiency
  • milk allergy
  • swallowed blood or foreign objects

Other at-risk groups who may experience vomiting blood include those who drink alcohol excessively.

Alcohol and vomiting blood

Vomiting blood might signal the more severe complications of regularly consuming too much alcohol, including:

  • A tear in the gastrointestinal tract: The increased pressure in the food pipe, stomach, and gut that comes from forceful vomiting can also lead to a tear in the intestines. This can be life-threatening in some cases. Accompanying symptoms can include sudden and severe chest pain that might spread to the back, sweating, shortness of breath, and stomach pain.
  • Cirrhosis: The regular overconsumption of alcohol can cause scarring of the liver, as well as other medical conditions. Blood vessels may then burst, causing an excess of blood in the vomit. Weakness, fainting, and rectal bleeding might also accompany hematemesis.
  • Ulcers: These might develop because of the acid content of alcohol. This can lead to irritation in the stomach and the development of ulcers. Other giveaway signs of stomach ulcers include a severe gut bleed, dark red or black stools, stomach pain, or pain in the lower part of the chest.

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Dilated pupils while vomiting blood can be a sign that the body is going into shock.

The color and consistency of the blood may vary depending on the cause and physical location of the bleeding. Blood can range from bright red to a coffee ground appearance.

Depending on the cause of the bleeding, people may experience other symptoms that they should discuss with a doctor. People should seek immediate medical attention if they experience any of the following along with vomit in the blood.

These symptoms could indicate the presence of shock:

  • dizziness, feeling faint, or fainting
  • confusion
  • cool, clammy, pale skin
  • a rapid heart rate, anxiety, or agitation
  • enlarged pupils
  • blurred vision
  • nausea
  • weakness
  • rapid, shallow breathing
  • reduced urine production

People should seek care in an emergency room if they are experiencing severe stomach pain, vomiting large amounts of blood, have had several episodes of vomiting, or any other concerning symptoms.

Diagnosis includes a detailed history, physical exam and may involve radiology procedures, such as a CT scan, an X-ray, or an endoscopy. Radiology tests can help the medical team work out the source of the bleed.

An endoscopy involves using a lighted scope to examine the upper portion of the gut for any causes of bleeding.

As the condition causing hematemesis might be viral or bacterial, diagnosis may involve specific blood tests and stool sample analyses.

In cases where the doctor suspects an arterial bleed, they may request an angiogram.

An angiogram involves inserting a thin tube and wire through the artery in the groin. A surgeon performs the procedure while the individual is under sedation.

After injecting an iodine dye for more precise imaging, X-rays can help doctors to check for blockages.

Certain medications and surgery can usually treat hematemesis.

In severe cases of hematemesis where the blood flow is heavy, an individual might need a drip or a blood transfusion. In life-threatening instances, they might require emergency resuscitation and fluid or blood replacement

Treating hematemesis depends on the cause of the condition. Many techniques for stopping internal bleeding involve passing instruments down an endoscope and sealing an internal wound.

The outlook for vomiting blood depends on several factors, including what caused the bleeding and the speed with which a person receives treatment.

Anyone who vomits blood should go straight to an emergency room or seek immediate medical treatment.