Vomiting blood, medically termed hematemesis, is a symptom that demands immediate attention. This indicates bleeding within the upper gastrointestinal (GI) tract, which includes the esophagus, stomach, and the duodenum. While causes range from minor irritation to serious conditions, hematemesis is always treated as potentially life-threatening until the source and severity are determined. The initial appearance of blood can sometimes be misleading regarding the true extent of the internal issue.
When to Seek Emergency Medical Care
The appearance of the blood offers initial clues, but professional medical evaluation is always necessary. Bright red blood suggests a fresh, active bleed not exposed to stomach acid. Vomit resembling dark brown or black coffee grounds indicates the blood has been partially digested, suggesting a slower or longer-present bleed. Regardless of color, call emergency services immediately if you vomit a large volume of blood or experience signs of significant blood loss.
Signs of hypovolemic shock require emergency intervention. These include dizziness, fainting, rapid heart rate, or weakness. Other indicators are cool, clammy skin, fast and shallow breathing, confusion, or anxiety. Prompt treatment is necessary to stabilize blood volume and prevent potential organ failure.
Minor Causes Originating in the Esophagus and Stomach Lining
Less severe causes often involve superficial damage to the upper GI tract lining. A Mallory-Weiss tear is a small laceration in the lower esophagus or upper stomach. This tear is typically caused by a sudden, forceful rise in pressure, often from violent retching and vomiting. Bleeding from a Mallory-Weiss tear is usually self-limited and resolves spontaneously within a few days.
Inflammation in the esophagus or stomach lining can also cause minor bleeding. Esophagitis, inflammation of the esophagus, frequently results from severe acid reflux irritating the tissue. Gastritis involves inflammation of the stomach lining, often caused by regular use of non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or excessive alcohol consumption. This superficial damage may produce smaller amounts of blood streaks or flecks, which can appear as coffee grounds if the blood remains in the stomach. These conditions require medical evaluation to confirm the diagnosis and prevent further irritation.
Major Conditions Requiring Urgent Intervention
Serious causes involve deeper tissue damage or vascular abnormalities leading to rapid blood loss. Peptic ulcer disease (PUD) is a common cause of severe upper GI bleeding. A peptic ulcer is an open sore on the stomach or duodenum lining, typically due to Helicobacter pylori infection or chronic NSAID use. The ulcer can erode deeply, potentially hitting an underlying artery and causing a substantial hemorrhage.
Esophageal varices are another serious condition: extremely dilated, fragile blood vessels in the lower esophagus. Varices develop due to high blood pressure in the portal vein system (portal hypertension), often caused by advanced liver disease or cirrhosis. Because these vessels are thin-walled and under high pressure, they can rupture suddenly, leading to massive, life-threatening bleeding.
Tumors in the upper GI tract, such as stomach or esophageal cancers, can also cause bleeding. As these masses grow, they break down surrounding tissue and compromise blood vessels, resulting in chronic or acute bleeding. Bleeding from a tumor signals a serious underlying pathology requiring immediate diagnostic workup.
How Healthcare Providers Determine the Source
Upon arrival at a medical facility, the first step is rapid assessment and patient stabilization. This often involves blood tests to check the extent of blood loss and clotting ability. A complete blood count determines if anemia is present, and clotting tests assess underlying issues that could worsen bleeding. A physical examination and medical history provide initial clues, such as identifying risk factors like chronic liver disease or recent NSAID use.
The most definitive diagnostic tool is an upper endoscopy, also called an esophagogastroduodenoscopy (EGD). This procedure involves inserting a long, flexible tube with a camera down the throat to visualize the lining of the esophagus, stomach, and duodenum. Endoscopy is beneficial because it confirms the bleeding site and allows the clinician to treat the bleeding immediately, such as by injecting medication or applying clips to stop the hemorrhage. Imaging tests like CT angiography may be used if the bleeding source cannot be identified by endoscopy.