Vomiting blood, or hematemesis, involves expelling blood from the upper gastrointestinal tract (esophagus, stomach, and duodenum). The blood’s appearance varies from bright red (fresh bleeding) to dark brown or black, resembling coffee grounds (blood exposed to stomach acid). Hematemesis is a serious symptom requiring immediate medical attention. This article provides general information on potential causes, not medical advice.
Common Causes
Peptic ulcers are open sores on the lining of the stomach or duodenum. These ulcers can form due to Helicobacter pylori infection or regular use of nonsteroidal anti-inflammatory drugs (NSAIDs). When an ulcer erodes into a blood vessel, it can bleed, causing hematemesis.
Gastritis, an inflammation of the stomach lining, is another common cause. Factors like excessive alcohol, NSAID use, or certain infections can cause it. The inflammation can disrupt the stomach’s protective barrier, making blood vessels vulnerable to erosion and bleeding.
Esophageal varices are enlarged, fragile veins in the lower esophagus. These typically develop in individuals with severe liver disease, like cirrhosis. The thin walls of these engorged veins are susceptible to rupture, leading to severe bleeding.
A Mallory-Weiss tear is a laceration in the lining of the esophagus or its junction with the stomach. This tear often occurs after forceful or prolonged vomiting or retching, causing a sudden pressure increase within the abdomen and esophagus. Any intense vomiting can lead to this injury and bleeding.
Severe esophagitis, an inflammation of the esophageal lining, can cause hematemesis. This condition is linked to gastroesophageal reflux disease (GERD). Constant irritation and damage from stomach acid can break down esophageal tissue, causing it to bleed.
Less Frequent but Serious Causes
Certain cancers, particularly those affecting the esophagus or stomach, can cause hematemesis. While less common, a tumor can bleed directly into the gastrointestinal tract as it invades surrounding tissues. Pancreatic cancer, though rare, can also cause bleeding by invading the duodenum.
Blood in vomit may originate from swallowed blood, not the digestive tract itself. This can occur following a severe nosebleed or bleeding in the mouth. The swallowed blood then irritates the stomach, leading to vomiting.
Ingestion of a foreign body can cause hematemesis. Sharp objects can directly injure the mucosal lining, causing bleeding. While many ingested objects pass without issue, some can cause significant irritation, laceration, or even perforation of the digestive tract.
Blood clotting disorders can contribute to hematemesis. These disorders impair the body’s ability to form clots, increasing bleeding risk in the upper gastrointestinal tract. Certain medications, including blood thinners, can also interfere with clotting.
When to Seek Immediate Medical Help
Any instance of vomiting blood requires immediate medical attention. Even if the amount appears small, assessing internal bleeding severity without medical evaluation is difficult. All cases of hematemesis are considered potentially serious until the underlying cause is identified.
Seek emergency medical care if the vomit contains large amounts of blood or has a dark, coffee-ground appearance. These characteristics indicate a significant or ongoing bleed.
Additional warning signs include feeling dizzy or lightheaded, especially upon standing, or experiencing fainting spells. Other serious symptoms accompanying hematemesis may include a rapid heart rate, shortness of breath, confusion, severe abdominal pain, or cold, clammy, and pale skin. These signs suggest a severe loss of blood and require immediate intervention.
Diagnostic Steps and Treatment Approaches
Medical professionals begin with a detailed medical history and physical examination. This gathers information on symptom onset, blood appearance and volume, and relevant medical conditions. Blood tests check for blood loss severity, clotting ability, and overall health.
An upper endoscopy is a common diagnostic procedure for identifying the source of upper gastrointestinal bleeding. During this procedure, a thin, flexible tube with a camera is passed down the esophagus, through the stomach, and into the duodenum, for visual inspection. Imaging studies, like a CT scan, may also locate the bleeding source or identify structural issues.
Treatment focuses on stopping bleeding and addressing the underlying cause. During an endoscopy, techniques like cauterization, clipping, or medication injection can control active bleeding. Medications, like stomach acid reducers, are often prescribed to promote healing and prevent further bleeding, especially for ulcers or gastritis.
Supportive care is crucial, especially with significant blood loss. This may involve intravenous fluids or blood transfusions for substantial loss. If other treatments fail or bleeding is severe, surgery may be necessary.