Hematemesis means vomiting blood. It’s a very serious symptom. It usually means you have bleeding in your upper GI tract. Internal bleeding can be an emergency.
Hematemesis means vomiting blood. You may vomit blood along with your stomach contents, or blood alone. It may be fresh and bright red, or older, darker and coagulated, like coffee grounds. Hematemesis is a sign of internal bleeding from the upper portion of your digestive tract — the esophagus, stomach and first portion of your small intestine called the duodenum. If you're vomiting blood, you should seek medical attention right away.
There are many possible causes of blood in your vomit. Some are very serious. Healthcare providers can’t tell how serious it is until they investigate and diagnose the cause. For this reason, healthcare providers treat all cases of hematemesis as emergencies until they know better, and you should too.
Blood in your vomit is never normal. A small amount may indicate a more benign cause. For example, you might see a small amount of blood in your vomit simply from the trauma of vomiting. But there are many other reasons why hematemesis can occur. It’s important to call your healthcare provider if you’re vomiting blood at all.
Vomiting itself is unlikely to cause death, but severe blood loss can. If you’re bleeding a lot, you’re at risk of going into hypovolemic shock, which can cause organ failure and death. Fortunately, this is a rare event. But if you're vomiting a lot of blood, you should seek treatment right away. You may need treatment beyond just stopping the bleeding.
In general, vomiting blood is a sign of bleeding inside your upper GI tract. Your upper GI includes your esophagus, stomach and duodenum. It’s possible to vomit blood if you swallow it due to a nosebleed or mouth bleed. But if you haven’t swallowed blood, it’s coming from inside your upper digestive system.
Bright red blood is fresh and indicates an active bleed, which might be heavier and more urgent. Coffee ground vomit — blood that looks brown and lumpy — is older blood. It may indicate a slower bleed or one that has stopped. It usually takes a significant amount of bleeding to trigger vomiting.
Conditions that most commonly cause hematemesis include:
Other possible causes include:
Healthcare providers can stop active internal bleeding in several ways. This will be their first concern when you are vomiting blood. However, if your bleeding is caused by a chronic condition, that might be harder to cure. It’s possible to have recurring hematemesis if the underlying condition isn’t fixed.
Hematemesis is always treated as an emergency. When you arrive, your healthcare team will assess your condition to find out what kind of immediate support you need. If you show signs of severe blood loss, they will treat this first with IV fluids, blood transfusions and oxygen support if necessary. These steps are referred to as resuscitation.
After resuscitation, your healthcare team will need to investigate the cause of your condition. They will want to know when you started vomiting blood, what it looked like and whether it has ever happened before. They will want to know if you have any other symptoms. They will also obtain a detailed history of your medication use, including aspirin, NSAIDs and blood thinners.
To locate the source of the bleeding and make sure it has stopped, your healthcare team will need to look inside your upper GI tract. The most efficient way to do this is with an upper endoscopy exam. An endoscopy allows healthcare providers to see inside your GI tract and stop the bleeding.
During the exam, you’ll have medicine to relax and sedate you. Your healthcare provider will pass the endoscope — a lighted camera on a long, thin tube — down your throat and into your duodenum. When they find the source of the bleeding, they can pass medical tools through the tube to seal the wound.
What happens next depends on what your healthcare provider learns from the exam. They might need to take a tissue sample from the endoscope to analyze in the lab (biopsy). Most causes of upper GI bleeding are effectively treated with medication. Some cases of severe upper GI bleeding may require surgery to fix.
Seek medical attention immediately if you’re vomiting blood. You might want to call an ambulance if you have other emergency symptoms, such as:
A note from Cleveland Clinic
If you’re vomiting blood, you likely know something is wrong. Vomiting is different from spitting blood or even coughing up blood. Vomit comes from your digestive tract, and it takes a significant amount of blood to trigger vomiting and show up in your vomit. Active internal bleeding can be an emergency.
Your healthcare team will treat it as an emergency until they know more about the cause. They’ll work to control the bleeding and stabilize your condition before addressing the underlying cause. Not all causes are emergencies, but many are serious and may require further treatment.
Last reviewed by a Cleveland Clinic medical professional on 06/10/2022.
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