Coffee Ground Emesis (Vomitus)

What is coffee ground emesis (vomitus)?

Coffee ground emesis (CGE) is vomit that looks like coffee grounds. The appearance of coffee grounds comes from coagulated blood in your vomit. It may appear dark red, brown or black, depending on how old the blood is. Blood in your vomit is a symptom that healthcare providers take very seriously.

What does it mean when you vomit up coffee grounds?

Coffee ground vomitus is an indication of internal bleeding somewhere in your upper GI tract. Your upper GI tract includes your esophagus, stomach and the first part of your small intestine (duodenum). There are many possible causes, but internal bleeding is always treated as a medical emergency.

What is the difference between coffee ground vomit and hematemesis?

Hematemesis means vomiting blood, so coffee ground emesis is one type of hematemesis. With coffee ground emesis, the blood is not fresh or bright red. By the time your vomiting reflex was triggered, the blood had been in your GI tract long enough to begin to dry, congeal, and turn to a darker color.

Is coffee ground emesis active bleeding?

Blood that has had time to coagulate and turn coffee brown or black is not fresh. That means that the bleeding has slowed or even stopped, at least temporarily. However, the cause of the bleeding may still be active, and there may be more to come. Healthcare providers treat CGE as an acute condition.

What are the possible causes of coffee ground emesis?

Coffee ground vomit indicates upper gastrointestinal bleeding. The cause of the bleeding may not be the same as the cause of the vomiting. Common causes of upper GI bleeding include:

• A bleeding ulcer in your stomach or duodenum.
• Inflammation of your stomach or esophagus.
• Swollen and bleeding veins in your esophagus or stomach.
• A tear in your esophagus caused by violent vomiting.
• Cancer of the stomach, the esophagus or the pancreas.
• Viral hemorrhagic fevers, such as Ebola.

Could coffee ground emesis be caused by a bowel obstruction?

A small bowel obstruction could cause you to vomit, but it wouldn’t explain the bleeding. Bleeding in your bowels (your lower GI) won’t show up in your vomit, but it might show up in your poop. Dark red blood in your poop could be from your small bowel. Upper GI bleeding may cause black, tarry stools.

What risk factors are associated with upper GI bleeding?

You’re more likely to experience upper GI bleeding and hematemesis if you:

• Have late-stage liver disease.
• Have late-stage kidney disease.
• Have alcohol use disorder.
• Take NSAIDs
• Have a blood clotting disorder.
• Are over the age of 60.

How do healthcare providers treat coffee ground emesis?

Your healthcare provider will work to isolate the cause and stop the bleeding if necessary. Often, the bleeding stops on its own, but they will still need to treat the underlying cause.

Initial examination

Your healthcare provider will begin by asking you about your medical history, including medications. They may ask if you have any other symptoms, such as:

• Upper abdominal pain.
• Abdominal distension.
• Chronic acid reflux.
• Black, tarry poop.
• Frequent vomiting or coughing.
• Loss of appetite or involuntary weight loss.

Stabilization

Coffee ground vomit doesn’t usually indicate severe active bleeding. But if your provider suspects severe blood loss, they might want to test your blood volume. They do this by taking a blood sample through an IV. If your blood volume is low, they will work to replace it with IV fluids or blood transfusion.

Medical tests

To confirm upper GI bleeding and investigate possible causes, your healthcare provider may give you various medical tests, including:

• Basic metabolic panel.
• Gastric or fecal occult blood tests (to look for blood in your emesis or poop).
• Liver function and kidney function tests.
• Electrocardiogram (EKG test).
• Upper GI X-ray series.
• Upper endoscopy (EGD test).

Treatment

Your provider may be able to address the bleeding during an upper endoscopy exam. This exam involves passing a tiny camera on a tube down your throat and into your upper GI tract while you are sedated. If the camera reveals the source of the bleeding, your provider can treat it by passing tiny medical tools through the tube such as clips or cauterization tools.

If they can’t find the source of the bleeding or stop it through these methods, sometimes providers will order special bleeding scans to try and locate the source of the bleeding along the length of your intestines. If the source of bleeding is identified, it can be treated in a minimally invasive manner such as embolization. This procedure is done by an interventional radiologist, a physician specially trained in this sort of procedure.

Embolization involves accessing the bleeding vessel by inserting a catheter in your neck veins or groin veins. Once the culprit blood vessel is identified, your physician can block off the blood vessel by injecting special material to clog up the vessel.

If this is unsuccessful, the option of last resort is usually exploratory surgery. Providers can usually do this by minimally invasive methods. A laparoscopy uses the aid of a small camera and small surgical tools through small abdominal incisions (usually 1/2 inch or less).

Once your provider has identified and treated the source of the bleeding, they will address your underlying condition. You may have a chronic disease that needs comprehensive treatment. You may need to make lifestyle changes, or you may only need medication to treat an acute condition.

When should I see a doctor about coffee ground emesis?

If you ever have coffee ground emesis or any kind of blood in your vomit, seek medical attention right away. You may want to call an ambulance if you have other emergency symptoms, such as:

• Dizziness or lightheadedness.
• Faintness.
• Disorientation or confusion.
• Jaundice (yellowing in the whites of your eyes).
• Severe abdominal pain.
• Severe chest pain.

A note from Cleveland Clinic

Vomiting is uncomfortable enough, but if your vomit looks like coffee grounds, you might find it doubly unsettling. Vomit that looks like coffee grounds isn’t normal. It means that something is bleeding inside you. There are many possible causes, some more serious than others. But any bleeding can become an emergency if it doesn’t stop. If you ever see coffee ground emesis, seek medical attention right away. It’s important to find out the cause and to treat it as soon as possible.