Vomiting Blood (Hematemesis): Causes, Symptoms, Diagnosis, and Treatment

Overview

• Vomiting blood (hematemesis) means blood is present in vomit and usually comes from the upper gastrointestinal (GI) tract.
• It is treated as a medical emergency until evaluated.
• Blood may appear bright red or dark/coffee-ground–like.
• Bleeding may stop on its own, but it can also become severe or life-threatening.
• Any amount of blood in vomit is abnormal and requires medical assessment.

What Is Vomiting Blood (Hematemesis)?

Vomiting blood—medically called hematemesis—refers to blood in vomit that originates from the upper GI tract, which includes the esophagus, stomach, and duodenum (the first part of the small intestine).

This is different from:

• Coughing up blood (hemoptysis), which comes from the lungs or airways.
• Vomiting swallowed blood, such as blood from a nosebleed, which may appear in vomit but did not originate in the digestive tract.

Is Vomiting Blood an Emergency?

Yes. Vomiting blood is treated as a medical emergency until a healthcare professional determines otherwise.

Authoritative medical sources consistently emphasize that:

• Bleeding may stop quickly, but it can also become severe.
• The seriousness cannot be determined without evaluation.
• Severe blood loss can lead to shock, organ failure, and death.

What Does Vomiting Blood Look Like?

The appearance of blood in vomit can reflect different bleeding patterns:

• Bright red blood
  Indicates fresh, active bleeding that may be rapid or heavy.
• Dark brown or “coffee-ground” material
  Indicates older blood that has been exposed to stomach acid long enough to darken, often associated with slower bleeding.
• Vomiting blood with black, tar-like stools (melena)
  Indicates a large amount of bleeding into the gastrointestinal tract.

Regardless of appearance, all forms require medical evaluation.

Common Causes of Vomiting Blood

Vomiting blood results from bleeding in the upper digestive system.

Esophageal Causes

• Mallory–Weiss tears: Tears in the lining of the esophagus or stomach caused by repeated vomiting, retching, coughing, or straining.
• Esophageal varices: Enlarged veins in the esophagus, commonly associated with liver cirrhosis and increased portal vein pressure; these veins may bleed heavily.
• Esophagitis: Inflammation of the esophagus, often related to acid reflux.
• Esophageal cancer: Can cause bleeding into the esophagus.

Stomach Causes

• Gastric (stomach) ulcers: Breaks in the stomach lining that may bleed, sometimes heavily.
• Gastritis: Inflammation of the stomach lining, with causes similar to ulcers.
• Stomach cancer: Can cause bleeding into the stomach.

Duodenal Causes

• Duodenal ulcers: Ulcers in the first part of the small intestine that may bleed significantly.

Other Verified Causes

• Anti-inflammatory medications and aspirin, which can contribute to ulcer formation and bleeding.
• Alcohol-related liver disease, which can lead to varices.
• Swallowed blood, such as after a nosebleed.

Vomiting Blood in Children

Vomiting blood can also occur in children. Verified causes include:

• Swallowed foreign objects
• Congenital abnormalities
• Swallowed blood, such as from nosebleeds

There is no high-quality evidence available showing that nutritional deficiencies directly cause vomiting blood.

Symptoms That May Occur With Vomiting Blood

Vomiting blood may occur with:

• Dizziness
• Fainting

Signs of shock, such as shallow breathing, confusion, or collapse, require immediate emergency care.

There is no high-quality evidence available linking vomiting blood directly with fatigue, shortness of breath, pale or clammy skin, or rapid heartbeat in the reviewed sources.

How Doctors Diagnose Vomiting Blood

Medical evaluation focuses on stabilization and identifying the bleeding source. Verified diagnostic steps include:

• Clinical assessment, including medical history and physical examination
• Blood tests, used to estimate blood loss, determine whether transfusion is needed, and assess liver function
• Endoscopy (gastroscopy), which allows direct visualization of the esophagus, stomach, and duodenum and often identifies the bleeding source

There is no high-quality evidence available confirming routine use of imaging studies for initial diagnosis in the reviewed sources.

Treatment for Vomiting Blood

Treatment depends on the severity and underlying cause. Verified approaches include:

• Initial stabilization, including intravenous fluids and, if necessary, blood transfusions
• Endoscopic treatment, using instruments passed through an endoscope to stop active bleeding
• Surgery, in cases of severe or ongoing bleeding when other measures fail

Once bleeding is controlled, further treatment focuses on the underlying cause.

There is no high-quality evidence available supporting routine use of acid-reducing medications for all cases of vomiting blood.

Possible Complications

If not treated promptly, vomiting blood can lead to:

• Severe blood loss
• Anemia
• Hypovolemic shock
• Organ failure

There is no high-quality evidence available directly demonstrating that early medical care always reduces these risks, although emergency evaluation is consistently recommended.

When to See a Doctor

Seek immediate medical care if you vomit blood. Authoritative guidance supports urgent evaluation because:

• Blood in vomit is never normal.
• Even small amounts may indicate a serious condition.
• Bleeding can worsen rapidly without warning.

Frequently Asked Questions

APA Reference List

American Cancer Society. (2025, July 17). Hematemesis (vomiting blood). https://www.cancer.org/cancer/managing-cancer/side-effects/low-blood-counts/hematemesis.html

Cleveland Clinic. (n.d.). Coffee ground emesis (vomitus): Causes, what it is & treatment. https://my.clevelandclinic.org/health/symptoms/23153-coffee-ground-vomitus

Cleveland Clinic. (n.d.). Vomiting blood (hematemesis): Causes, what it is & treatment. https://my.clevelandclinic.org/health/symptoms/17708-vomiting-blood

DeMarco, C. (2025, March 14). What is hematemesis? Vomiting blood, explained. MD Anderson Cancer Center. https://www.mdanderson.org/cancerwise/what-is-hematemesis–vomiting-blood–explained.h00-159774867.html

Lynch, K. L. (2024, February). Mallory-Weiss syndrome. MSD Manual Professional Edition. https://www.msdmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/mallory-weiss-syndrome

Mayo Clinic. (n.d.). Gastrointestinal bleeding: Diagnosis and treatment. https://www.mayoclinic.org/diseases-conditions/gastrointestinal-bleeding/diagnosis-treatment/drc-20372732

MedlinePlus. (2024, October 30). Mallory-Weiss tear. https://medlineplus.gov/ency/article/000269.htm

MedlinePlus. (2025, January 24). Vomiting blood. https://medlineplus.gov/ency/article/003118.htm

MSD Manual Consumer Version. (n.d.). Esophageal varices. https://www.msdmanuals.com/home/digestive-disorders/gastrointestinal-bleeding/esophageal-varices

Patient.info. (n.d.). Vomiting blood (haematemesis): Causes and symptoms. https://patient.info/digestive-health/vomiting-blood-haematemesis

StatPearls Publishing. (2024). Upper gastrointestinal bleeding. In StatPearls (NCBI Bookshelf). National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK470300/