Coffee ground emesis (or vomitus) is vomit that looks like coffee grounds. It’s dark brown or black in color with a lumpy texture. The appearance comes from old and coagulated blood in your gastrointestinal tract. It’s a sign of internal bleeding.
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.
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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.
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.
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.
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 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.
You’re more likely to experience upper GI bleeding and hematemesis if you:
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.
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:
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.
To confirm upper GI bleeding and investigate possible causes, your healthcare provider may give you various medical tests, including:
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.
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:
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.
Last reviewed by a Cleveland Clinic medical professional on 05/27/2022.
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