Vomiting blood is a backward flowing (regurgitation) of blood through the upper gastrointestinal (GI) tract. The upper GI tract includes the stomach, mouth, throat, esophagus (the swallowing tube), and the first part of the small intestine.

Hematemesis; Blood in the vomit

Vomiting blood results from upper gastrointestinal bleeding. It can sometimes be difficult 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.

There are several reasons why someone may vomit blood. For example, vomiting that is very forceful or continues for a very long time may cause a tear in the small blood vessels of the throat or the esophagus, producing streaks of blood in the vomit.

Other causes may include:

• Bleeding ulcer in the stomach, first part of the small intestine, or esophagus
• Bleeding esophageal varices or stomach varices
• Defects in the blood vessels of the GI tract
• Infection of the stomach and intestines (gastroenteritis)
• Inflammation of the esophagus lining (esophagitis)
• Inflammation of the stomach lining (gastritis)
• Irritation or erosion of the lining of the esophagus or stomach
• Swallowing blood (for example, swallowed after a nosebleed)
• Tumors of the stomach or esophagus

Although not all situations are the result of a major medical problem, this is difficult to know without a medical evaluation. Seek immediate medical attention.

Call your doctor or go to the emergency room if vomiting of blood occurs -- this requires immediate medical evaluation.

The doctor 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 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)
• Rectal exam
• Tube through the nose into the stomach to check for blood
• X-rays

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

• Blood transfusions
• Fluids through a vein
• Medications to decrease stomach acid,
• Possible surgery if bleeding does not stop

Overton DT. Gastrointestinal bleeding. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. Columbus, OH: McGraw-Hill; 2006:chap 74.