Hematemesis (Vomiting Blood)

Medically reviewed by Robert Burakoff, MD

Hematemesis is a medical term for vomiting blood. Blood is typically bright red or has a "coffee ground" appearance. It often appears with other symptoms like abdominal pain, weakness, or tachycardia (rapid heartbeat).

Hematemesis may indicate an underlying condition like a peptic ulcer, gastritis, or esophageal varices. Immediate medical attention is crucial for determining the cause and initiating treatment that helps prevent further complications.

Hematemesis Symptoms

Hematemesis often appears with symptoms like the following:

• Abdominal pain or discomfort, such as burning or gnawing, which may signal a stomach or intestinal condition (e.g., an ulcer)

• Nausea or retching

• Weakness, fatigue, and dizziness
  

• Orthostatic or supine hypotension (a blood pressure drop after standing or lying down, which can occur with severe gastric bleeding

• Tachycardia (rapid heartbeat, which can happen with severe bleeding)

It's crucial for anyone experiencing hematemesis to seek immediate medical attention to determine the underlying cause. Rapid treatment can prevent serious complications.

What Causes Hematemesis?

Hematemesis occurs due to bleeding in the gastrointestinal (GI) tract, which leads to blood being expelled through vomiting. The GI tract includes the mouth, throat, esophagus, stomach, and the first part of the small intestine (duodenum).

The most common causes of hematemesis include:

• Peptic ulcers: These sores develop on the lining of the stomach or the duodenum, often due to infection with Helicobacter pylori (H. pylori) bacteria or the use of non-steroidal anti-inflammatory drugs (NSAIDs).

• Esophageal varices: These enlarged veins in the esophagus are typically seen in people with liver disease, such as cirrhosis (extreme liver scarring and damage).

• Swallowing blood: For example, you might swallow blood after a nosebleed.
  

• Gastritis: This is inflammation of the stomach lining, often caused by alcohol use, chronic (long-term) vomiting, or certain medications.

• Mallory-Weiss tears: These tears occur in the lining of the esophagus due to repeated vomiting.

• Liver disease: Conditions such as cirrhosis or hepatitis (liver inflammation) can increase the risk of esophageal varices and hematemesis.

• Alcohol use: Excessive alcohol consumption can lead to gastritis, liver disease, and an increased risk of GI bleeding.

Risk Factors

Several factors may increase the risk of experiencing hematemesis, including:

• Age: Older adults are more prone to developing GI conditions like peptic ulcers and esophageal varices, which increases their risk of hematemesis.

• Chronic NSAID use: Regular use of NSAIDs can irritate the stomach lining, leading to the development of peptic ulcers and an increased risk of bleeding.

• H. pylori infection: Infection with H. pylori bacteria increases the likelihood of developing peptic ulcers, which can lead to hematemesis if left untreated.

• Smoking: Tobacco use can worsen existing gastrointestinal conditions and increase the risk of developing peptic ulcers (stomach sores) or gastrointestinal bleeding.

• Excessive alcohol consumption: Alcohol gastritis is stomach inflammation due to alcohol use. Vomiting blood can result from gastrointestinal (GI) bleeding, a potential long-term effect of alcohol gastritis.

Understanding these risk factors can help you and your healthcare providers determine whether or not you're at a higher risk of developing hematemesis. You can then work together to take preventive measures or try early interventions to manage underlying conditions.

Diagnosis

Diagnosing hematemesis typically involves a combination of medical history assessment, physical examination, and diagnostic tests to determine the underlying cause of the bleeding.

The diagnostic approach may vary depending on your clinical presentation, underlying medical conditions, and the severity of bleeding. Early diagnosis and intervention are crucial.

Medical History and Physical Examination

Your healthcare provider will inquire about symptoms, including the frequency and duration of hematemesis and any associated symptoms, such as abdominal pain or dizziness.

They will complete a physical examination to assess vital signs (e.g., blood pressure) and identify any signs of gastrointestinal bleeding

Laboratory Tests

Blood tests may be ordered to assess your hemoglobin levels and check for signs of anemia, which can indicate significant blood loss. Hemoglobin is a protein in red blood cells that helps carry oxygen throughout the body.

Additional tests, such as liver function tests or blood clotting tests, may be performed to evaluate liver function and clotting factors.

Endoscopy

Upper endoscopy, also known as esophagogastroduodenoscopy (EGD), is a key diagnostic procedure for hematemesis. During this procedure, a flexible tube with a camera (endoscope) is inserted through the mouth and into the esophagus, stomach, and duodenum to visually inspect the GI tract for signs of bleeding, such as ulcers or varices.

If bleeding is detected, therapeutic interventions can help stop the bleeding. Possible procedures include:

• Cauterization: Destroying tissue (e.g., an ulcer) with an electrical current

• Band ligation: Placing rubber bands around tissue (e.g., esophageal varices) to stop bleeding

• Targeted medication: Inserting medication into the site of bleeding

Imaging Studies

Imaging studies such as X-rays or computed tomography (CT) scans may be recommended to evaluate the extent of bleeding and identify any underlying structural abnormalities in the gastrointestinal tract.

Hematemesis Treatment

If hematemesis involves significant blood loss, immediate emergency treatment is essential. This may include:

• Oxygen therapy to ensure adequate oxygenation due to potential blood loss-induced anemia (low red blood cells or hemoglobin)

• Blood transfusions to replace lost blood volume

• Upper GI endoscopy (esophagogastroduodenoscopy or EGD) and possible laser treatment to stop the bleeding at its source

• Intravenous (IV) fluid administration to maintain fluid balance and prevent dehydration

• Medications that reduce stomach acid production

Surgical intervention may be necessary if bleeding persists despite initial interventions or in cases of severe hemorrhage that cannot be controlled endoscopically.

Prevention

Preventing hematemesis involves managing underlying conditions like peptic ulcers, gastritis, or liver disease with medication and lifestyle changes. Here are some strategies:

• Avoid irritants like alcohol and NSAIDs like aspirin to protect the stomach lining

• Treat H. pylori infection, if present, to reduce the risk of bleeding due to peptic ulcers

• Avoid smoking to reduce the risk of gastrointestinal conditions

• Seek prompt medical attention for symptoms like abdominal pain or vomiting blood

• Avoid excessive alcohol consumption

Taking these steps can help promote gastrointestinal health and reduce the risk of hematemesis.

Related Conditions

Several conditions are related to hematemesis. These include:

• Hematochezia: Passing blood in stools, typically due to bleeding in the lower GI tract and often caused by conditions such as hemorrhoids, anal fissures, inflammatory bowel disease (IBD), or colorectal cancer

• Peptic ulcers: Sores on the stomach or duodenum lining, often caused by factors such as H. pylori infection or the use of NSAIDs, which can lead to gastrointestinal bleeding and hematemesis
  

• Esophageal varices: Enlarged veins in the esophagus, commonly associated with cirrhosis, which can increase the risk of bleeding and lead to hematemesis when they rupture

A Quick Review

Hematemesis is a medical condition characterized by the release of blood from the GI tract through vomiting. Symptoms include vomiting bright red blood or vomit resembling coffee grounds, abdominal pain or discomfort, weakness, and dizziness. Common causes include peptic ulcers, esophageal varices, gastritis, and liver disease.

Hematemesis may indicate a serious underlying condition that requires prompt diagnosis and treatment to prevent complications. See a healthcare provider right away if you or a loved one vomits blood. Early treatment is important.

Frequently Asked Questions

When should you go to the hospital for blood in vomit?

If you or a loved one vomits blood, see your healthcare provider right away. Vomiting blood can be a sign of a serious condition that requires immediate treatment.

Is it normal to vomit blood after drinking alcohol?

Vomiting blood after drinking alcohol is not normal. Excessive alcohol consumption can lead to gastritis, liver disease, and an increased risk of gastrointestinal bleeding.

Can anxiety cause blood in my vomit?

Anxiety itself is not a direct cause of hematemesis. However, severe anxiety or panic attacks may lead to conditions like gastritis or peptic ulcers, which may result in gastrointestinal bleeding and subsequent hematemesis.

What does throwing up blood look like?

Hematemesis typically presents as bright red or with a "coffee ground" appearance.

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