The upper GI (gastrointestinal) tract includes the mouth, throat, esophagus (swallowing tube), stomach and the duodenum (first part of the small intestine). Blood that is vomited may come from any of these places.
Vomiting that is very forceful or continues for a very long time may cause a tear in the small blood vessels of the throat. This may produce streaks of blood in the vomit.
Swollen veins in the walls of the lower part of the esophagus, and sometimes the stomach, may begin to bleed. These veins (called varices) are present in people with severe liver damage.
Other causes may include:
Bleeding ulcer in the stomach, first part of the small intestine, or esophagus
Blood clotting disorders
Defects in the blood vessels of the GI tract
Swelling, irritation, or inflammation of the esophagus lining (esophagitis) or the stomach lining (gastritis)
Swallowing blood (for example, after a nosebleed)
Tumors of the mouth, throat, stomach or esophagus
When to Contact a Medical Professional
What to Expect at Your Office Visit
The doctor will examine you and ask questions such as:
When did the vomiting begin?
Have you ever vomited blood before?
How much blood was in the vomit?
What color was the blood? (Bright or dark red or like coffee grounds?)
Have you had any recent nosebleeds, surgeries, dental work, vomiting, stomach problems, or severe coughing?
What other symptoms do you have?
What medical conditions do you have?
What medicines do you take?
Do you drink alcohol or smoke?
Tests that may be done include:
Blood work, such as a complete blood count (CBC), blood chemistries, blood clotting tests, and liver function tests
Esophagogastroduodenoscopy (EGD) (placing a lighted tube through the mouth into the esophagus, stomach and duodenum
Nuclear medicine scan
Tube through the nose into the stomach and then applying suction to check for blood
If you have vomited a lot of blood, you may need emergency treatment. This may include:
Administration of oxygen
EGD with application of laser or other modalities to stop the bleeding
Fluids through a vein
Medications to decrease stomach acid
Possible surgery if bleeding does not stop
Overton DT. Gastrointestinal bleeding. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. Columbus, OH: McGraw-Hill; 2006:chap 74.
Henneman PL. Gastrointestinal Bleeding. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, PA: Mosby Elsevier; 2009:chap 22.
Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.