What Is Hematemesis (Vomiting Blood)?

Medically Reviewed by Minesh Khatri, MD on February 20, 2024
3 min read

Hematemesis is a serious condition that causes you to throw up blood. It’s more than just a fleck of blood in your spit, though; vomiting blood is a sign that you’re bleeding in your digestive system, and you should get medical attention right away.

Hematemesis is a sign of bleeding in your upper digestive tract. This includes the first part of your intestine, your stomach, or your esophagus. Your esophagus is the tube that connects your mouth to your stomach. 

Some common hematemesis causes include:

Stomach ulcers. Known as a peptic ulcer, this condition is a painful, open sore in your stomach lining. You can also get these sores in the first part of your intestine; these are called duodenal ulcers. These sores can damage an artery, causing you to vomit blood.

Esophageal varices. Esophageal varices are swollen vessels in the tube from your mouth to your stomach. These occur when scarring or clots in your liver block normal blood flow. The blood will redirect to these smaller vessels, which aren’t meant to carry a lot of blood. When they become too swollen, they can leak blood or burst and cause life-threatening bleeding.

Gastroesophageal reflux disease. Also known as GERD, this condition happens when stomach acid backwashes into your esophagus and causes inflammation. Severe cases can irritate your lining and cause bleeding.

Mallory-Weiss tear. This is a bleeding tear in your esophagus lining that occurs after violent  and prolonged coughing or vomiting. It’s often linked to heavy alcohol drinking

Less Common Causes of Vomiting Blood

There are other less common hematemesis causes, too. These can include:

  • Radiation exposure
  • Stomach cancer
  • Esophagus cancer
  • Swallowing a poison
  • Hemorrhagic fever, where an infectious disease causes severe illness and internal bleeding
  • A blood condition like anemia or hemophilia

The main symptom of hematemesis is blood in your vomit. The blood and vomit can be:

  • Bright red blood
  • Brown 
  • Black 
  • Like coffee grounds

You might also have blood in your stool, which looks like sticky, black tar.

When you lose a lot of blood, your organs don’t get enough oxygen and you may go into shock. If you are vomiting blood and also have the following symptoms, call 911:

If you think you’re vomiting blood, you should go to a hospital right away. If you can, bring a small sample of it with you. Your doctor will need details about what the vomit looks like. 

They will examine you and ask details about how you’re feeling. You might need some tests to confirm where and why you’re bleeding. These can include:

  • Blood tests to look for infections or clotting problems
  • X-ray scans
  • Endoscopy, where a tube with a camera is placed into your esophagus to get images
  • Nuclear medicine scan, which uses radiation to take images of how your organs

Since vomiting blood is a medical emergency, if you have symptoms of shock and trouble breathing, your doctor will give emergency treatment first.

True hematemesis is a medical emergency and can’t be treated at home. Your doctor will need to find the cause of your bleeding and stop it, then treat any underlying conditions. If you have only a little blood loss, they might give you medications and some fluids. 

If you have a lot of blood loss, you might need:

  • Blood transfusion
  • Intravenous, or IV, fluids
  • Oxygen and breathing assistance
  • Blood-pressure medications

Once you’re stable, your doctor will treat the cause. Treatment can include antacid medications, antibiotics, embolization to block a blood vessel, and other treatments.

It’s common to have blood in your spit after brushing and flossing your teeth. You might also vomit swallowed blood after a nosebleed, but this isn’t hematemesis. 

Sometimes you might spit up bloody material from your lungs, too. This is usually foamy and bright red and happens after a lot of coughing. It’s called hemoptysis and is commonly confused with vomiting blood. 

If you’re spewing vomit from your mouth with bright red blood but you haven’t had a nosebleed, or if it’s black or looks like coffee grounds, seek medical care immediately. If it looks like coffee grounds, it means blood has been there for a few hours.