Blood vomiting (hematemesis) – causes, treatment

Vomiting blood (hematemesis)

Hematemesis is the medical term for vomiting blood (vomiting blood), usually due to bleeding in the upper gastrointestinal (gastrointestinal) tract. Any bleeding in the gastrointestinal tract is potentially life-threatening with a mortality rate of around 10 percent and should therefore be checked out by a doctor immediately.

What is hemorrhage?

Infogram on the anatomy and causes of haemorrhage. Click to enlarge.

Hematemesis is vomiting of blood as a result of bleeding in the upper gastrointestinal (gastrointestinal) tract, particularly the esophagus (gullet), stomach, and duodenum (duodenum).

The vomited blood is usually bright red in color. However, if this has come into contact with stomach acid, so-called hematin is formed, giving the blood a color similar to coffee grounds.

In the long term, blood vomiting due to blood loss can lead to anemia ( pallor , shortness of breath , weakness ), circulatory disorders and, in the case of massive blood loss, to shock-like conditions ( anxiety , tachycardia , pale and cold-sweaty skin, impaired consciousness ), which is why immediate medical evaluation is required if haematemesis is present .


Blood vomit, along with tarry stool , is the main symptom of bleeding in the upper gastrointestinal tract, which can be attributed to various causes. The upper gastrointestinal tract includes the esophagus (gullet), stomach, and duodenum (duodenum).

The most common causes of vomiting are bleeding ulcers (ulcers) in the stomach (ulcus ventriculi) or duodenum (ulcus duodeni) and damage to the mucous membrane or ruptured varicose veins (varicose veins) in the esophagus or stomach (gastric fundal varices).

In addition, Mallory-Weiss syndrome, which is associated with abrupt and jerky vomiting with subsequent bleeding in the gastrointestinal tract due to longitudinal mucosal lesions, and erosive gastritis (precursor to gastric ulcer) can lead to hematemesis.

In rare cases, hematemesis can also be caused by gastric cancer , gastric polyps or vascular diseases. Severe nosebleeds that have entered the esophagus and are then vomited up, on the other hand, are very rarely the cause of hematemesis.

Diseases with this symptom

Diagnosis & History

Hematemesis is diagnosed based on the presence of blood in the vomit and known previous illnesses that can cause blood vomiting.

The color of the blood can already indicate the underlying cause. Bright red blood usually indicates bleeding in the esophagus, while a black or coffee grounds-like color indicates bleeding damage in the stomach or duodenum.

To pinpoint the source of the bleeding, an endoscopy of the esophagus and the gastrointestinal tract should be performed.

In some cases, blood analyses, X-rays and sonographies (ultrasound examinations) are also used to confirm the diagnosis.

Hematemesis can usually be treated well, depending on the underlying disease. In order to avoid impairment of the circulatory system due to massive blood loss, the cause of hematemesis should be treated quickly.


Vomiting blood is just a symptom, not a disease in its own right. From this it can be deduced that there is a disease that causes vomiting of blood. Most of the complications that can arise are due to the underlying condition.

Complications arising directly from the process of vomiting blood may include aspiration of the vomit and anxiety . During aspiration, the vomit enters the trachea , i.e. it is inhaled. This initially creates a strong urge to cough , the aim of which is to get the aspirated vomit out of the airways . If this is unsuccessful, there is a risk of suffocation in the worst case. If the vomit gets into the lungs , it can lead to infection and inflammation there.

Fear and even panic attacks are another complication of vomiting blood. In the worst case, the patient is paralyzed by fear and unable to act rationally. This in turn favors aspiration of the vomit.

The underlying disease that triggers the symptom of vomiting blood can bring with it various complications, some of which are life-threatening. An example of this is severe blood loss with a wide range of negative consequences. In general, the consequences and complications of the diseases that may be present cannot be specified in detail, since a number of diseases and injuries can lead to the vomiting of blood.

When should you go to the doctor?

In hematemesis, which is vomiting blood, the blood comes from one of the areas of the upper gastrointestinal tract: the esophagus, stomach, or duodenum. Vomit blood that has passed through the stomach takes on a blackish, coffee grounds-like appearance due to the gastric acid, which is why vomiting blood is popularly referred to as coffee grounds vomiting.

On the other hand, vomited blood that has not been in contact with stomach acid appears a fresh red and usually comes from a damaged varicose vein in the esophagus. In rare cases, vomit blood can also come from the nose and throat area, for example in the case of severe nosebleeds. A doctor should always be consulted if hematemesis occurs. After all, 10% of bleeding from the gastrointestinal tract is fatal!

The main causes of hemorrhage are ulcers in the stomach or duodenum, gastritis, mucosal injuries and torn varicose veins in the esophagus or stomach. Hematemesis occurs in Mallory-Weiss syndrome associated with mucosal lesions, which is often preceded by excessive alcohol consumption for several years. In addition to these particularly frequent triggers of blood vomiting, vascular diseases, stomach polyps and stomach cancer should also be considered when determining the cause.

In the case of vomiting of blood, the family doctor is a competent contact who, after an initial assessment, usually involves other specialists in the treatment: above all the gastroenterologist , internist or oncologist .

Treatment & Therapy

In the case of hematemesis, the therapeutic measures are primarily aimed at stopping the bleeding immediately and eliminating the underlying disease. In many cases, fluid and electrolytes are infused intravenously to compensate for the loss of water and minerals as a result of the hemorrhage to stabilize the circulatory system .

In the event of massive blood loss, an intravenous infusion with blood reserves or erythrocyte concentrates (concentrated red blood cells) may be necessary. To clarify the cause of the hematemesis, an emergency endoscopy (mirroring) is usually carried out promptly, in the course of which the gastrointestinal bleeding can not only be localized but, if necessary, the underlying disease can be eliminated at the same time.

If, for example, there is a torn esophageal varix (varicose vein in the esophagus), this can be sclerosed (sclerosed) endoscopically and the bleeding stopped. In the presence of a bleeding gastric ulcer (gastric ulcer), surgery may be indicated to eliminate the ulcer. If the gastric ulcer is caused by an infection with Helicobacter pylori, then antibiotic therapy (including amoxicillin or clarithromycin ) is used.

In addition, regardless of a possible bacterial contamination, proton pump inhibitors such as pantoprazole or omeprazole are used to reduce gastric acid production in order to accelerate the regeneration (healing) of the gastric mucosa and prevent renewed hemorrhage.

Outlook & Forecast

Acute hemorrhage is an emergency. Action must be taken quickly. Life-saving haemostasis must be carried out immediately.

Another disease is often the cause of the hemorrhage. Once it is clear what it is, the sputum can be cured. If this clinical picture develops after great physical exertion, the walls of blood vessels are most likely torn. It is then important to protect the body sufficiently. The injured blood vessels heal by themselves.

If the cause of the vomiting is an eating disorder , this is a high burden on the organism. Regular vomiting can damage blood vessels. The person affected should definitely start treatment for the eating disorder. If successful, the blood vomiting is relieved, in the best case a complete cure.

Blood vomiting is also a possible side effect of a strong or chronic cough . Appropriate treatment of the cold will improve the symptoms. After the cold has completely healed, the bloody sputum will also be gone.

In the worst case, the vomiting of blood comes from a tumor or a benign ulcer. The symptoms will only subside when the tumor or benign ulcer is surgically removed.


Hematemesis can be prevented by measures that minimize the risk of mucosal defects. An unhealthy diet, excessive alcohol and nicotine consumption , and long-term use of certain pain-relieving medications ( acetylsalicylic acid , diclofenac ) are among the risk factors for conditions that can lead to hematemesis.

You can do that yourself

Vomiting blood is almost always a sign of a serious illness. In the event of a first-time attack, the necessary self-help measures must be initiated immediately. The emergency doctor must be informed immediately. If possible, the affected person should raise their upper body slightly. It is best for an affected person to sit down and lean their upper body slightly forward. Under no circumstances should the patient lie on his back, as there is a risk that the blood will get into the lungs .

Vomiting blood often causes shock in those affected . The patient should then be placed in the shock position with the legs elevated. If the patient loses consciousness before the emergency doctor arrives, they should be placed in the recovery position .

A disease of the gastrointestinal tract is usually responsible for the regular vomiting of blood . Gastritis is often the trigger. In this case, the patient can do a lot himself to ensure that the underlying disease heals and that the symptom of vomiting blood occurs less frequently. A change in lifestyle is particularly helpful. Anyone who smokes and drinks alcohol regularly should refrain from doing so. It is also better to replace heavy, high-fat food with light, vegetarian food. In addition, too much black or very strong coffee can irritate the stomach. If the gastritis is stress-related, learning a relaxation technique will help .

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.