Vomiting Blood (Hematemesis)

ByJanis Updated

Vomiting blood, also known as hematemesis, refers to the expulsion of a noticeable amount of blood through vomit. The blood can appear bright red, which usually suggests active, ongoing bleeding, or dark and grainy, resembling coffee grounds, which typically points to older blood that has remained in the stomach for some time and been partially digested. This condition is very different from minor traces of blood in vomit caused by issues like a nosebleed, gum irritation, or sore throat, which are usually less concerning and often harmless.

However, true hematemesis is often a medical emergency and may signal serious problems in the upper gastrointestinal tract, including the esophagus, stomach, or upper part of the small intestine. Immediate medical evaluation is necessary because the bleeding can be rapid, severe, and even life-threatening.

Common Causes of Vomiting Blood

There are a variety of underlying conditions that may lead to vomiting blood. Some causes are mild and resolve with treatment, while others are critical and demand emergency care:

1. Stomach Ulcers

Ulcers are open sores in the lining of the stomach, often caused by Helicobacter pylori (H. pylori) infection or frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. These sores can erode nearby blood vessels, leading to bleeding and eventually hematemesis.

2. Esophageal Varices

In people with liver disease, especially cirrhosis, pressure in the portal vein can increase and lead to the formation of enlarged veins (varices) in the esophagus. These swollen veins can rupture, causing massive bleeding into the stomach and subsequent vomiting of blood. This is one of the most dangerous causes and requires immediate intervention.

3. Gastritis or Esophagitis

Inflammation of the stomach lining (gastritis) or esophagus (esophagitis) due to acid reflux, infection, alcohol use, or certain medications can lead to irritation and bleeding. Over time, this can result in vomiting blood, especially if the inflammation is not properly treated.

4. Mallory-Weiss Tear

A Mallory-Weiss tear is a small tear in the lining of the esophagus, usually caused by forceful vomiting, dry heaving, or retching. This type of tear is commonly seen after binge drinking or intense coughing and can lead to sudden bleeding.

5. Stomach or Esophageal Cancer

Cancers in the upper digestive tract may bleed slowly over time or bleed suddenly. The blood may eventually appear in vomit, especially if the tumor erodes nearby blood vessels. While less common than other causes, this is a serious possibility that must be ruled out by medical testing.

6. Medication Reactions

Certain medications like blood thinners, aspirin, or NSAIDs can either damage the stomach lining or increase the risk of bleeding. Individuals using these medications should be extra cautious if vomiting blood occurs.

Warning Signs That Require Immediate Medical Care

Call emergency services or visit the nearest ER if vomiting blood is accompanied by any of the following symptoms:

  • Dizziness or fainting
  • Rapid heart rate or very low blood pressure
  • Abdominal pain or bloating
  • Cold, clammy skin
  • Confusion or unusual fatigue
  • Black, tar-like stools (called melena)
  • Pale skin or yellowing of the eyes (jaundice)
  • Difficulty breathing or chest pain

These signs may indicate significant internal bleeding, organ damage, or shock, and should never be ignored.

Gentle Supportive Care at Home

Once emergency causes are ruled out and your doctor confirms it’s safe to manage recovery at home, the following tips can help promote healing and comfort:

Dietary Adjustments

  • Eat bland, soft foods like plain rice, bananas, toast, and oatmeal. These reduce irritation and are easier to digest.
  • Avoid acidic or spicy foods, such as citrus, tomatoes, chili, and fried items.
  • Limit or eliminate alcohol, caffeine, and carbonated drinks.
  • Eat smaller, more frequent meals to reduce stomach pressure.

Hydration and Positioning

  • Sip fluids slowly—opt for water, clear broths, or herbal teas like ginger or chamomile (only if your doctor approves).
  • Remain upright after eating to prevent acid reflux.
  • Elevate your upper body while sleeping with extra pillows or a bed wedge to reduce nighttime discomfort.

Lifestyle Tips

  • Avoid smoking and secondhand smoke, which can delay stomach lining recovery.
  • Take all prescribed medications (e.g., proton pump inhibitors, antacids) exactly as directed.
  • Track any new or recurring symptoms, including fatigue, dark stools, or abdominal pain.

What to Avoid During Recovery

To promote healing and avoid further irritation:

  • Avoid NSAIDs (like ibuprofen or aspirin) unless specifically advised by your doctor.
  • Refrain from heavy lifting or strenuous physical activity.
  • Don’t lie down flat immediately after meals.
  • Skip unregulated herbal supplements, which may irritate the digestive tract or interfere with medications.

When to Call Your Doctor Again

Even after initial treatment, call your healthcare provider immediately if you experience:

  • New or recurring episodes of vomiting blood
  • Black or tar-like stools
  • Worsening fatigue, lightheadedness, or weakness
  • Pain while swallowing or increasing abdominal pain
  • Allergic reactions to medication (e.g., rash, swelling, nausea

Health Writer

Janis's areas of expertise include nutrition, exercise, stress management, and mental health. She is passionate about educating and empowering people to take control of their health and make positive changes that can last a lifetime. Janis believes that small, sustainable changes are the key to long-term success, and she works with her clients to develop personalized plans that fit their individual needs and lifestyles.