Vomiting Blood: Causes, Symptoms, And Treatment Options
Learn about vomiting blood (hematemesis), its causes, symptoms, risk factors, complications, and treatment options. Seek immediate medical attention for this serious condition.
Written by Dr.Sonia Bhatt
Last updated on 3rd Jul, 2025
Introduction
Hematemesis refers to the act of vomiting blood, which can occur alongside stomach contents or on its own. The blood may appear fresh and bright red, or older, darker, and coagulated, resembling coffee grounds. Hematemesis indicates internal bleeding in the upper digestive tract, which includes the oesophagus, stomach, and the first part of the small intestine, known as the duodenum. If you experience vomiting blood, it is important to seek medical attention immediately. This article will explore the causes, symptoms, and treatment of vomiting blood.
Causes of Vomiting Blood
Conditions that most commonly cause hematemesis or vomiting blood include:
Bleeding ulcers: A peptic ulcer is an open sore in your stomach or duodenum, often caused by a bacterial infection or the regular use of NSAIDs or aspirin.
Acute inflammation: Inflammation of the oesophagus or stomach lining can cause bleeding from the underlying arteries. Common causes include heavy alcohol consumption, aspirin, NSAIDs, and severe acid reflux.
Enlarged blood vessels that rupture: Portal hypertension, often a result of cirrhosis, increases pressure in the abdominal veins, which can lead to the enlargement of veins in the oesophagus and stomach. These veins can become fragile and easily rupture, causing potentially life-threatening bleeding.
Chronic pancreatitis: Long-term pancreatitis can damage the blood vessels surrounding the pancreas, leading to rupture and bleeding that may travel into the duodenum.
Other potential causes include:
Traumatic injury: A direct, blunt injury to the stomach or oesophagus may cause acute bleeding. Internal injuries can also occur rarely as a result of medical procedures.
Mallory-Weiss syndrome: A Mallory-Weiss tear is a tear in the oesophagus caused by severe vomiting, often after excessive alcohol consumption.
Tumours: Both benign and malignant tumours can cause bleeding. A bleeding tumour requires testing to rule out cancer of the stomach, oesophagus, or pancreas.
Angiodysplasias: These are abnormal surface blood vessels that can lead to bleeding in the stomach and intestines.
Symptoms Associated with Vomiting Blood
When vomiting blood, individuals may experience additional symptoms, including:
Bright red or dark brown blood: The blood may be fresh and bright red or darker and resembling coffee grounds, depending on how long it has been in the stomach.
Abdominal pain: Pain or discomfort in the stomach or abdomen may accompany the vomiting of blood.
Dizziness or light-headedness: A result of significant blood loss, leading to a drop in blood pressure.
Fatigue: Feeling weak or tired due to blood loss.
Rapid heart rate: An increased heart rate can occur as the body attempts to compensate for the loss of blood.
Shortness of breath: This may be a sign of significant blood loss affecting the body’s oxygen levels.
Risk Factors
Several factors can increase the risk of vomiting blood, including:
Chronic alcohol use: Heavy drinking is linked to liver disease, ulcers, and inflammation in the stomach and oesophagus, all of which increase the likelihood of bleeding.
Use of NSAIDs or aspirin: These medications can irritate the stomach lining, increasing the risk of ulcers and bleeding.
Liver disease: Conditions such as cirrhosis can cause portal hypertension, leading to the rupture of varices in the oesophagus and stomach.
Peptic ulcers: Individuals with a history of ulcers, particularly if untreated, are at greater risk for bleeding.
Gastroesophageal reflux disease (GERD): Severe or long-term acid reflux can contribute to bleeding in the oesophagus or stomach lining.
History of trauma or surgery: Previous injuries or medical procedures involving the stomach or oesophagus may increase the risk of internal bleeding.
Age: Older individuals may have a higher risk due to conditions such as diverticulosis, angiodysplasias, or stomach cancer.
Complications of Vomiting Blood
Vomiting blood can lead to several serious complications, such as:
Severe blood loss: Significant blood loss from vomiting can lead to hypovolemic shock, a condition where there is not enough blood to circulate properly, leading to organ failure.
Anaemia: Chronic blood loss or large amounts of blood loss at once can result in anaemia, which may cause fatigue, weakness, and shortness of breath.
Aspiration pneumonia: Vomiting blood can lead to the inhalation of blood into the lungs, causing an infection.
Shock: Severe blood loss can result in shock, which is a life-threatening condition requiring immediate medical attention.
Diagnostic Procedures
The diagnostic procedure includes:
1. Initial Medical Assessment
The first step in diagnosing the cause of vomiting blood involves a thorough medical assessment. This includes:
Medical history: Your doctor will ask about your symptoms, the amount of blood being vomited, any previous medical conditions, and any medications you are taking.
Physical examination: This may involve checking for signs of shock, abdominal tenderness, or any other physical signs that could indicate the source of the bleeding.
2. Diagnostic Tests and Imaging
Following the initial assessment, additional tests and imaging may be required to identify the cause of vomiting blood:
Blood tests: These can help assess the severity of blood loss, check for anaemia, and evaluate liver function.
Endoscopy: A flexible tube with a camera is used to visually inspect the oesophagus, stomach, and duodenum to locate the source of bleeding, such as ulcers or varices.
CT scan or MRI: These imaging techniques may be used if internal bleeding from the pancreas or other organs is suspected.
X-rays: In some cases, X-rays may help detect complications, such as perforations or other anatomical issues.
Angiography: This test involves injecting a contrast dye into the blood vessels to locate the bleeding source, especially in cases of varices or other vascular abnormalities.
Treatment Options for Vomiting Blood
Hematemesis is always treated as a medical emergency. Upon arrival, your healthcare team will immediately assess your condition to determine the necessary support. If signs of severe blood loss are present, resuscitation measures will be implemented first. This includes:
IV fluids to rehydrate and stabilise blood pressure.
Blood transfusions to replace lost blood and improve haemoglobin levels.
Oxygen support if required to ensure adequate oxygen levels in the body.
Once resuscitation is underway, the next step is to investigate the underlying cause of the bleeding. Your healthcare team will ask about when you started vomiting blood, the appearance of the blood, and whether this has happened before. They will also inquire about any other symptoms you may be experiencing and review your medication history, including the use of aspirin, NSAIDs, and blood thinners.
To pinpoint the source of the bleeding and confirm that it has stopped, an upper endoscopy is typically performed. This procedure involves using a lighted camera on a long, flexible tube to examine the upper gastrointestinal (GI) tract. The endoscope is passed down your throat and into the duodenum, where your healthcare provider can locate the bleeding site. If necessary, medical tools are passed through the tube to seal the wound and stop the bleeding.
Depending on the findings, further steps may be required:
Biopsy: A tissue sample may be taken during the endoscopy for laboratory analysis to better understand the cause of the bleeding.
Medication: Most causes of upper GI bleeding can be effectively treated with medications, such as proton pump inhibitors or other therapies specific to the cause.
Surgery: In rare cases where severe bleeding persists or the source cannot be treated with endoscopy, surgery may be required to repair the damage and stop the bleeding.
The treatment approach will depend on the specific cause of the bleeding and the severity of your condition.
Conclusion
Vomiting blood is a medical emergency that requires immediate attention. It can be caused by conditions like bleeding ulcers or ruptured blood vessels. Prompt treatment, including resuscitation, diagnostic tests, and endoscopy, is crucial to identify and stop the bleeding. With timely care, most causes can be effectively treated, but quick intervention is vital for preventing serious complication
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