Vomiting blood is a medical emergency, so call emergency services or go to the ER right away.
Emergency
Vomiting blood (hematemesis) needs immediate medical care. Call 911 or go to the ER.
Possible causes
- Stomach ulcers.
- Gastritis.
- Esophageal varices.
- Mallory-Weiss tear.
- Swallowed blood from a nosebleed.
- Cancer.
Color
Bright red means fresh bleeding. Coffee ground color means digested blood.
While waiting
Don’t eat or drink.
Terms
Vomiting blood is called hematemesis. It can be bright red, dark red or look like coffee grounds (blood partly digested by stomach acid). It always needs urgent medical evaluation, because it can signal serious bleeding in the upper digestive tract.
Causes in the upper digestive tract
- Peptic ulcers in the stomach or duodenum. H. pylori infection and NSAID use (aspirin, ibuprofen, naproxen) are major causes.
- Gastritis and erosive esophagitis.
- Esophageal varices, swollen veins in people with liver cirrhosis, which can bleed massively.
- Mallory-Weiss tear, a tear in the esophagus lining after forceful vomiting or retching, often after heavy drinking.
- Stomach or esophageal cancer.
- Swallowed blood from a nosebleed or mouth injury.
- Aortoenteric fistula and other rare causes.
- Certain medicines such as blood thinners.
How serious
Upper gastrointestinal bleeding leads to about 150 hospital admissions per 100,000 people a year in some countries, and death rates range from about 2% to 10%, depending on cause and patient. Variceal bleeding has higher mortality.
Symptoms of significant blood loss
Dizziness, fainting, rapid heartbeat, pale or clammy skin, low blood pressure, shortness of breath, black tarry stools and confusion.
What to do
Call 911 or go to the emergency room immediately. Do not drive yourself. While waiting, sit up or lie on your side to avoid choking, do not eat or drink and do not take aspirin or NSAIDs. Save a sample or photo of the vomit if you can.
Hospital care
Treatment includes IV fluids, blood transfusion if needed, medicines such as proton pump inhibitors and an urgent upper endoscopy to find and stop the bleeding.
Prevention
Limit alcohol, avoid unnecessary NSAIDs, treat H. pylori, and follow up on liver disease.
Emergency guidance
Vomiting blood (hematemesis) is a medical emergency. Causes include stomach ulcers, gastritis, esophageal varices in liver disease, tears of the esophagus (Mallory-Weiss), swallowed blood from a nosebleed and cancers. Bright red blood suggests fresh bleeding and coffee ground appearance suggests partly digested blood. Call 911 or go to the emergency room immediately.
Hospital care
Treatment includes IV fluids, blood transfusion if needed, medicines to reduce stomach acid and endoscopy to find and treat the bleeding source. Risk factors include NSAID use, heavy alcohol use, Helicobacter pylori infection and cirrhosis. Do not eat or drink while waiting for care, and do not drive yourself if feeling faint.
Based on data from the American College of Gastroenterology and the NIH
