Vomiting blood, medically termed hematemesis, is a symptom that demands immediate attention. This occurrence signifies bleeding within the upper gastrointestinal (GI) tract, which includes the esophagus, stomach, and the first section of the small intestine, the duodenum. Ignoring this symptom can have serious consequences, as it points to an underlying medical issue that requires professional diagnosis and management. Understanding how this bleeding presents provides important context for medical professionals when seeking care.
Understanding the Appearance and Urgency
The color and texture of the blood you vomit offer important clues about the source and speed of the bleeding. Bright red blood indicates fresh, acute bleeding, meaning the blood has not been altered by stomach acid. This presentation often suggests a rapid or actively bleeding source, frequently located in the esophagus or upper stomach. A large volume of bright red blood is a sign of a severe hemorrhage that requires emergency medical intervention.
In contrast, vomit that appears dark, granular, and resembles “coffee grounds” suggests the blood has been partially digested. Iron in the blood oxidizes upon contact with the highly acidic environment of the stomach, causing this dark, clotted appearance. This usually implies a slower bleed or one that has temporarily stopped, often originating lower in the stomach or duodenum. Even “coffee ground” emesis must be treated with urgency, as the underlying cause is still internal bleeding.
Beyond the visual characteristics of the blood, specific associated symptoms increase the level of urgency. Signs of severe blood loss, such as lightheadedness, dizziness, fainting, or a rapid heart rate, suggest the body is entering hypovolemic shock. If you experience any of these signs alongside hematemesis, immediate emergency medical services should be contacted.
Causes Related to Chronic Irritation and Inflammation
Conditions related to chronic irritation or inflammation of the lining are frequent causes of upper GI bleeding. Peptic ulcers are common, representing open sores that form in the lining of the stomach (gastric ulcers) or the duodenum (duodenal ulcers). These ulcers bleed when the erosion penetrates a blood vessel beneath the mucosal layer. Most peptic ulcers are caused by infection with the Helicobacter pylori bacterium or the prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen.
H. pylori colonizes the stomach lining and causes chronic inflammation, while NSAIDs compromise the stomach’s protective mucus layer by inhibiting the production of prostaglandins. Gastritis, which is inflammation of the stomach lining without the deep erosions of an ulcer, can also cause bleeding. Similarly, esophagitis, or inflammation of the esophageal lining, typically results from chronic gastroesophageal reflux disease (GERD), where stomach acid repeatedly damages the esophagus.
Forceful vomiting or retching can cause minor breaks in the mucosal lining by increasing pressure within the stomach. These small tears may cause a transient episode of hematemesis but typically heal spontaneously. Swallowed blood from an aggressive nosebleed (epistaxis) or a dental issue may also be mistaken for hematemesis upon vomiting. True hematemesis, however, signifies a breach in the integrity of the digestive tract itself.
Immediate Emergency Conditions
Esophageal varices involve abnormally enlarged, swollen veins in the lower esophagus and represent a high-risk emergency. These veins develop from portal hypertension, often a complication of severe liver disease such as cirrhosis. Because the walls of these distended veins are thin and fragile, they are prone to rupture, resulting in profuse, bright red bleeding that can be life-threatening.
The Mallory-Weiss tear is another serious cause, involving a laceration of the mucous membrane at the junction of the esophagus and stomach. This tear is caused by a sudden, severe increase in intra-abdominal pressure, typically from violent retching or vomiting. While many tears heal on their own, a deep laceration can involve an underlying artery and lead to significant, rapid blood loss. The initial vomiting may contain only food contents, followed immediately by hematemesis.
Upper GI bleeding can also be a symptom of malignancies affecting the esophagus or stomach, although this is less common. Tumors can erode through blood vessel walls as they grow, causing bleeding that may be intermittent or heavy. These conditions require immediate medical assessment due to the volume of blood loss that can quickly destabilize the body, often requiring resuscitation before definitive treatment.
Seeking Diagnosis and Treatment
When a patient presents with hematemesis, the immediate focus is stabilization, which involves restoring lost blood volume using intravenous fluids or blood transfusions. Once stable, the diagnostic process begins with a detailed medical history, focusing on the vomit’s appearance, NSAID use, and any history of liver disease. Blood tests are performed to assess the degree of blood loss and check for underlying issues like clotting disorders.
The most definitive procedure for identifying the source of bleeding is an upper endoscopy. During this procedure, a flexible tube equipped with a camera is passed down the esophagus, stomach, and duodenum. This allows the physician to directly visualize the GI tract, locate the exact source of the hemorrhage, and often treat it simultaneously. Endoscopic treatment can involve injecting medication into the bleeding site, applying heat (cauterization), or placing clips to close the vessel.
Treatment following diagnosis is tailored to the specific cause. Bleeding peptic ulcers are managed with high-dose acid-reducing medications called proton pump inhibitors (PPIs) to promote healing and reduce the risk of re-bleeding. Variceal bleeding requires specialized techniques like endoscopic banding to physically stop the hemorrhage, often combined with medications to lower portal pressure. In rare cases of uncontrollable bleeding or when endoscopic methods fail, surgical intervention may be required to repair the source.