Vomiting blood—known medically as haematemesis—can be an alarming experience. Whether it’s a few streaks in the vomit or a large amount, seeing blood come out this way is never considered normal and should always prompt medical attention. But what exactly causes it? How serious is it? And what tests or treatments are involved? Let’s break it down into something simple and human.
What is Vomiting Blood?
Vomiting blood, or haematemesis, refers to the presence of blood in the vomit. The blood may appear:
- Bright red (fresh bleeding),
- Dark red with clots (more significant bleeding),
- Or like coffee grounds—a sign that the blood has been in the stomach for some time and has been partially digested.
This symptom isn’t a disease on its own. Instead, it’s a warning sign—your body’s way of saying, “Hey, something’s not right inside.”
According to studies, upper gastrointestinal (GI) bleeding (which includes haematemesis) affects about 50–150 people per 100,000 each year. It’s more common in men, older adults, and those with a history of liver disease or ulcers.
How Does It Happen?
To understand how vomiting blood occurs, think of your digestive tract as a long, winding pipe. If any part of that pipe—especially in the upper part, like the oesophagus, stomach, or the first part of the small intestine (duodenum)—gets damaged, blood may leak into the digestive system. When that happens, it can mix with stomach contents and come out through vomiting.
Sometimes, the bleeding is slow and internal. Other times, it can be so fast that it leads to shock.
Imagine a hose with a hole in it. Depending on the size and pressure of the leak, water either drips, sprays, or gushes out. That’s exactly what happens with internal bleeding too.
What Causes Vomiting Blood?
There are many causes, ranging from mild irritation to life-threatening conditions. Here are the most common ones:
1. Peptic Ulcers – About 50% of cases
Ulcers are sores that form on the lining of the stomach or duodenum. They’re usually caused by H. pylori infection or long-term NSAID use (like aspirin or ibuprofen). When an ulcer erodes into a blood vessel, it can bleed heavily.
2. Gastritis or Erosive Gastritis – 15–20%
This is inflammation of the stomach lining, often triggered by alcohol, stress, infections, or medications. If the lining is irritated enough, it can bleed.
3. Oesophageal Varices – 10–15%
Seen mostly in people with liver cirrhosis, varices are swollen veins in the oesophagus. If one of these veins bursts, the bleeding can be sudden and massive. This is a medical emergency.
4. Mallory-Weiss Tear – 5–10%
This is a small tear in the lining where the oesophagus meets the stomach, often caused by forceful vomiting. It’s more common in heavy drinkers or after prolonged retching.
5. Stomach or Oesophageal Cancer
Tumours in the digestive tract may erode into blood vessels and cause bleeding. Although rare, this cause is more likely in older adults, smokers, or those with chronic acid reflux.
Who’s Most at Risk?
People with certain habits, conditions, or medications are more likely to experience haematemesis. Here are the key risk factors:
- Regular use of NSAIDs (e.g. ibuprofen, naproxen)
- Heavy alcohol use
- Liver disease (especially cirrhosis)
- Helicobacter pylori infection
- Smoking
- Older age
- History of ulcers or GI surgery
- Chemotherapy or radiotherapy
- Frequent vomiting from other causes
If any of these apply to you—or someone you care about—it’s worth being extra cautious.
Other Symptoms That Often Appear
Vomiting blood rarely comes alone. Here are other symptoms that may show up depending on the cause:
- Black, tarry stools (melena) – from digested blood passing through the intestines
- Abdominal pain or burning – especially in ulcers or gastritis
- Dizziness, weakness, or fainting – signs of significant blood loss
- Pale or cold skin – a potential sign of shock
- Yellowing of the skin (jaundice) – could point to liver issues
When the bleeding gets worse, blood pressure may drop, and heart rate may rise. In severe cases, a person may collapse or lose consciousness.
Tests to Identify the Cause
The gold standard test for vomiting blood is an upper gastrointestinal endoscopy.
Here’s what to expect:
- A thin, flexible tube with a camera (called an endoscope) is passed through the mouth into the stomach and upper intestines.
- You’ll likely be sedated so it’s not uncomfortable.
- The doctor can see exactly where the bleeding is coming from—and may even stop the bleeding during the procedure using special tools or clips.
Other supporting tests include:
- Blood tests to check for anaemia, clotting problems, or liver function.
- CT scans or ultrasounds (if varices or cancer are suspected).
- Stool tests to detect hidden blood.
Treatment for Vomiting Blood
First step: Stabilise.
If the bleeding is heavy, doctors will act quickly to give IV fluids, oxygen, or even blood transfusions.
Once stable, treatment depends on the cause:
🌟 Mainstream (Gold Standard) Treatment:
- Endoscopic therapy – To stop bleeding with banding (for varices), clips, or injections.
- Proton pump inhibitors (PPIs) – Like omeprazole, to reduce stomach acid and help ulcers heal.
- Antibiotics – If H. pylori is involved.
- Octreotide – For variceal bleeding, this medication reduces blood flow to the gut.
- Beta-blockers – Sometimes given after variceal bleeding to prevent recurrence.
💡 If the first treatment doesn’t work:
- Repeat endoscopy or surgery may be needed.
- Balloon tamponade (rare): A balloon is inflated inside the oesophagus to compress bleeding varices.
- Transjugular intrahepatic portosystemic shunt (TIPS) – A procedure for liver-related bleeding.
The overall success rate is high when treated promptly—but delayed treatment can be fatal.
Final Thoughts
Vomiting blood is never something to ignore. Whether it’s a little streak or a dramatic gush, it signals a problem deep within the digestive system. Sometimes it’s just a minor tear after vomiting. Other times, it could point to ulcers, liver problems, or even cancer.
If you or someone you know experiences this symptom, get help immediately. And remember, catching the cause early could mean the difference between a treatable condition and a life-threatening emergency.
References
- Upper GI Bleeding: Overview and Management – BMJ Best Practice, updated May 2023. https://bestpractice.bmj.com/topics/en-gb/144
- Haematemesis (Vomiting Blood) – Patient.info, reviewed March 2024. https://patient.info/digestive-health/vomiting-blood-haematemesis
- Gastrointestinal Bleeding – Causes and Treatments – Cleveland Clinic, 2023. https://my.clevelandclinic.org/health/diseases/14459-gastrointestinal-bleeding
- Acute Upper GI Bleeding in Adults – NICE Guidelines, UK, 2022. https://www.nice.org.uk/guidance/ng184