What would cause you to vomit blood

Hematemesis; Blood in the vomit

Vomiting blood is regurgitating (throwing up) contents of the stomach that contains blood.

Vomited blood may appear bright red, dark red, or look like coffee grounds. The vomited material may be mixed with food or it may be blood only.

Considerations

It may be hard to tell the difference between vomiting blood and coughing up blood (from the lung) or a nosebleed.

Conditions that cause vomiting blood can also cause blood in the stool.

Causes

The upper GI (gastrointestinal) tract includes the mouth, throat, esophagus (swallowing tube), stomach and the duodenum (first part of the small intestine). Blood that is vomited may come from any of these places.

Vomiting that is very forceful or continues for a very long time may cause a tear in the small blood vessels of the throat. This may produce streaks of blood in the vomit.

Swollen veins in the walls of the lower part of the esophagus, and sometimes the stomach, may begin to bleed. These veins (called varices) are present in people with severe liver damage.

Repeated vomiting and retching may cause bleeding and damage to the lower esophagus called Mallory Weiss tears.

Other causes may include:

• Bleeding ulcer in the stomach, first part of the small intestine, or esophagus
• Blood clotting disorders
• Defects in the blood vessels of the GI tract
• Swelling, irritation, or inflammation of the esophagus lining (esophagitis) or the stomach lining (gastritis)
• Swallowing blood (for example, after a nosebleed)
• Tumors of the mouth, throat, stomach or esophagus

Home Care

Get medical attention right away. Vomiting blood can be a result of a serious medical problem.

When to Contact a Medical Professional

Call your health care provider or go to the emergency room if vomiting of blood occurs. You will need to be examined right away.

What to Expect at Your Office Visit

The provider will examine you and ask questions such as:

• When did the vomiting begin?
• Have you ever vomited blood before?
• How much blood was in the vomit?
• What color was the blood? (Bright or dark red or like coffee grounds?)
• Have you had any recent nosebleeds, surgeries, dental work, vomiting, stomach problems, or severe coughing?
• What other symptoms do you have?
• What medical conditions do you have?
• What medicines do you take?
• Do you drink alcohol or smoke?

Tests that may be done include:

• Blood work, such as a complete blood count (CBC), blood chemistries, blood clotting tests, and liver function tests
• Esophagogastroduodenoscopy (EGD) (placing a lit tube through the mouth into the esophagus, stomach and duodenum)
• Rectal examination
• Tube through the nose into the stomach and then applying suction to check for blood in the stomach
• X-rays

If you have vomited a lot of blood, you may need emergency treatment. This may include:

• Administration of oxygen
• Blood transfusions
• EGD with application of laser or other modalities to stop the bleeding
• Fluids through a vein
• Medicines to decrease stomach acid
• Possible surgery if bleeding does not stop

References

Kovacs TO, Jensen DM. Gastrointestinal hemorrhage. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 126.

Meguerdichian DA, Goralnick E. Gastrointestinal bleeding. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 27.

Savides TJ, Jensen DM. Gastrointestinal bleeding. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 20.

Version Info

Last reviewed on: 1/14/2021

Reviewed by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Throwing-up blood or having some blood in your vomit is medically referred to as hematemesis. Normally, vomiting blood is related to changes in the organs along the digestive tract, like the stomach, esophagus or beginning of the intestines. 

Blood can appear in small or large quantities, and it should always be reported to a doctor. Blood can be associated with conditions that require immediate treatment. 

A diagnosis for hematemesis can be confirmed through an endoscopy, which assess the integrity of the digestive tract. Treatment is usually indicated by a doctor or gastroenterologist, and is aimed resolving at the underlying cause.

Blood in vomit can occur due to various condition, such as: 

1. Esophageal varices  

Esophageal varices are blood vessels in the esophagus that have become dilated. This can happen due to obstructed circulation within the hepatic portal, which is responsible for draining blood around the abdominal organs. With decreased flow or obstructions in the hepatic portal, pressure in the vessels around the esophagus will increase. This increased pressure causes dilation and bleeding. Blood can be noted in vomit or in the stools (which will appear to be black and have a foul odor), and many people may also experience dizziness and pallor. 

What to do: If you suspect varices and you are vomiting blood, you should proceed immediately to the emergency room to stop the bleeding. Once diagnosed, patients are usually monitored by a gastroenterologist. Treatment is aimed at improving the underlying cause of bleeding and preventing further hemorrhages. The doctor will often prescribe beta-blockers and may recommend surgery to repair the varices. 

2. Gastritis

Gastritis is characterized by inflammation in the stomach, which can occur when the protective mucus lining is destroyed and left untreated. Without the mucus lining, the stomach is prone to developing ulcers, which can bleed over time and lead to bloody vomit and dark stools. Other symptoms associated with gastritis include abdominal discomfort, burning in the stomach and nausea. If you think you may have gastritis, report your symptoms using our online gastritis quiz. 

What to do: You are advised to see your doctor for assessment to determine whether you have stomach inflammation. Once identified, treatment can be initiated. Usually it involves the use of stomach protectors to prevent further inflammation. These medications work by creating a barrier to block stomach acid from irritating stomach tissue, which promotes healing and relieves symptoms. Learn more about how gastritis is treated. 

Diet also plays a role in decreasing stomach inflammation. You should avoid spicy foods, sauces, fatty foods and alcohol, for example. Read more about what foods you should eat and what to avoid when treating gastritis. 

3. Esophagitis

Esophagitis is an inflammation that affects the esophagus, which is a structure that connects the mouth to the stomach. Most times, esophagitis is caused by infections, gastritis or reflux. People with esophagitis usually have excess acid in the esophagus, which can cause symptoms like heart burn, a bitter taste in the mouth, a sore throat and blood in vomit. 

What to do: It is important to identify the underlying cause of esophagitis to start appropriate treatment. Most times, the doctor will prescribe medication to decrease stomach acid production, like omeprazole. Dietary changes may also be required until the inflammation resolves and to prevent further worsening. 

4. Gastric ulcers 

Ulcers in the stomach mostly occur due to chronic gastritis that is left untreated. Stomach tissue that is constantly irritated by stomach acid can lead to the appearance of ulcers. 

Stomach ulcers usually cause stomach pain between meals or at night that does not resolve with medications. They can also cause nausea and vomiting with blood. 

What to do: Similar to gastritis or esophagitis, you should use stomach protectors as prescribed by your doctor to prevent further irritation of stomach tissue. This will help to heal the ulcers. Dietary changes should also be considered. 

5. Nose bleeds

When nose bleeds are very intense, the person may involuntarily swallow blood and then feel the urge to eliminate it by vomiting. Most times, throwing-up blood after a nose bleed is not serious, however you should monitor how often this happens and how much blood you lose. You should see your doctor if you vomit blood frequently after nose bleeds. 

What to do: To stop nose bleeding and prevent eventual bloody vomit, you should apply pressure on the nostrils with a napkin and apply ice to the nose. It also helps to lean your trunk forward instead of raising your chin up, to prevent blood from being swallowed. 

6. Cancer

The presence of stomach or esophageal tumors can lead to blood being eliminated through the mouth. This symptoms is more frequent in advanced stages of cancer. In addition to throwing-up blood, you may notice other symptoms like loss of appetite, weight loss, difficulty swallowing, dark stools with a foul odor, a feeling of a full stomach, excessive fatigue and abdominal discomfort. 

What to do: Stomach or esophageal cancer is suspected, the doctor should order testing like an endoscopy or biopsy for confirmation. Once diagnosed, treatment should be started promptly to avoid further cancer progression and complications.

Babies throwing up blood

Babies who vomit blood should be assessed by their doctor or pediatrician. Usually it is a sign of a hemorrhagic disease (like a vitamin K deficiency), liver disease, or a serious infection. Babies who breastfeed can also swallow blood from cuts or fissures in the mother’s nipple - this is a less serious condition.

In children, it is common to notice blood in vomit after losing a tooth, after a nose bleed, with strong coughing or from certain medications.