The medical word is hematemesis. This symptom is usually due to a problem in the upper intestine.
The upper intestine consists of the throat (esophagus), stomach, or the first part of the intestine (small intestine) known as the duodenum. There are a variety of different causes, which are discussed below.
Vomiting blood is a medical emergency. In many cases, the bleeding will stop fairly quickly, but in some cases it can become severe and life-threatening. Therefore, call an ambulance or go directly to the nearest emergency department if you vomit blood.
Understand the upper intestine
Upper tract and nearby organs
Your intestine (gastrointestinal tract) is the tube that begins in your mouth and ends in your lower part (anus).
The stomach produces acid that is not essential, but it helps digest food. After mixing in the stomach, food passes into the duodenum to be digested.
Some types of bleeding from the upper intestine
The type of bleeding is sometimes described as follows:
Dark Blood – This is often referred to as the “coffee grounds” color. This suggests that the bleeding has been relatively slow. The blood has been in contact with stomach acid long enough for the acid to turn the blood a dark brown / red color.
A large amount of bright red blood suggests a rapid and large hemorrhage.
Melaena: is the medical word for old, dark blood in the stool. If you have melaena, your stools turn very dark or black.
There is often a consistency similar to tar. Vomiting blood and having melaena are symptoms that often go hand in hand. Having both symptoms together means you have had a lot of bleeding from your gut.
Other symptoms can occur at the same time that you vomit blood. For instance:
- Tummy (abdominal) pain.
- High temperature (fever).
- Upset or other intestinal symptoms.
If you lose a lot of blood, it can make you feel dizzy or even pass out. The presence and type of other symptoms can help pinpoint a cause for the bleeding. Sometimes there are no other symptoms at first.
What are the causes of vomiting blood?
Common causes of vomiting blood include:
- A stomach ulcer
- Alcoholic liver disease.
- A tear in your throat (esophagus) caused by prolonged gagging.
- Swallowing blood from a nosebleed.
Vomiting blood should always be checked by a doctor and may need emergency treatment in the hospital.
Bleeding from the esophagus
Esophageal varicose veins : Varicose veins enlarge, the blood vessels swell in the lining of the esophagus or stomach. They are one of the possible complications of liver cirrhosis.
In cirrhosis, scarred liver tissue blocks blood flow through the liver. This causes an increase in pressure in the vein that carries blood from the intestine to the liver (the portal vein).
The increased pressure pushes into the intestine and causes the veins to swell in the throat. The swellings are quite fragile and can bleed a lot in the throat.
Inflammation of the esophagus (esophagitis) – Often due to acid reflux from the stomach (gastroesophageal reflux disease (GERD)). The inflamed esophagus sometimes bleeds.
Cancer of the esophagus sometimes causes bleeding into the esophagus.
Mallory-Weiss syndrome: is bleeding caused by a tear in the lining of the esophagus or stomach. The rupture can be caused by anything that leads to a sudden increase in pressure in the stomach or esophagus. For example, repeated gagging or vomiting, overexertion, violent coughing, or hiccups.
Stomach (gastric) ulcer. An ulcer is a small flaw in the lining of the stomach. An ulcer can bleed, sometimes excessively.
There are several causes of stomach ulcers, including:
- Infection with a germ (bacteria) called Helicobacter pylori. This can generally be treated quite easily.
- Anti-inflammatory drugs used to treat conditions such as arthritis sometimes cause stomach ulcers.
- Aspirin, commonly used to prevent blood clots.
- Stomach cancer sometimes causes bleeding in the stomach.
- Inflammation of the stomach lining (gastritis) has similar causes to stomach ulcers.
- Varicose veins in the lining of the stomach can occur in a similar way to esophageal varices described above.
- Mallory-Weiss syndrome can affect the lining of the stomach, described above.
Bleeding from the duodenum
Duodenal ulcer: An ulcer can bleed, sometimes excessively. Like stomach ulcers, a duodenal ulcer is usually caused by an infection with the germ (bacteria) called H. pylori. This can generally be treated quite easily.
Anti-inflammatory medications and aspirin, which are common causes of stomach ulcers, are rare causes of duodenal ulcers.
Inflammation of the lining of the duodenum (duodenitis) has causes similar to duodenal ulcers.
Rare causes of any part of the upper intestine
They may include:
- Radiation poisoning.
- Uncommon infections of the intestine.
- No cause identified. Even after testing, in some cases the cause cannot be found.
- Bleeding that has not come from the intestine.
Sometimes when blood is vomited, it has not come from the intestine. For example, if you have a nosebleed and the blood is then swallowed, you may vomit blood. It can also sometimes be difficult to tell if the blood has been vomited from the intestine or if it has been expelled.
A doctor’s evaluation
Your doctor will likely ask you several questions about the nature of the bleeding and ask if you have any other symptoms. He or she will also examine it.
The doctor will try to find out if this blood really comes from the upper intestine. Sometimes it is difficult to be sure. Sometimes it can be difficult to tell if the blood is:
Hemoptysis, that is, if the blood was spit out, it was not vomited.
Coming from somewhere in your mouth or nose that follows the back of your throat, which you then swallow and vomit again. For example, from a nosebleed.
The doctor will also try to judge how much blood you have lost and how bad it is. They will be able to tell this by what you tell them and also by checking your pulse and blood pressure.
If it is clear that the blood is coming from the upper part of the intestine, tests are usually done to identify the cause.
Usually, blood tests will be done to assess your general condition. For example, how much blood you have lost and whether you need an intravenous fluid or blood transfusion to counter a large amount of blood loss.
Also, blood tests can help assess your liver function if you have liver ‘scarring’ (cirrhosis) or to help diagnose or evaluate other causes of bleeding.
A gastroscopy (endoscopy) is an internal exam. A thin, flexible telescope is passed down your throat (esophagus) into your stomach and upper duodenum. The cause of the bleeding can often be identified endoscopically.
Which is the treatment?
Initial treatment may require a drip into a vein to give you fluid or even a blood transfusion if the bleeding is severe. This may not be necessary if the bleeding has been minor and has stopped.
However, if the bleeding is severe, a complete resuscitation and emergency blood / fluid replacement may be necessary.
This will depend on the cause. However, initial treatment to stop any ongoing bleeding can often be done through the use of instruments that can be passed through the endoscope. Occasionally, emergency surgery is needed to control severe ongoing bleeding.
Once the bleeding has stopped, further treatment depends on the cause. For more information, see the individual brochures on the various diseases that can cause vomiting in the blood.