Vomiting Blood (Haematemesis): Why Do People Throw Up Blood?

Mohd Sufyan   by Mohd Sufyan, BSME, MBA    Last updated on April 20, 2019,

vomiting blood or puking blood

Vomiting blood (hematemesis)

Vomiting blood, also called hematemesis, is the puking up of stomach contents along with blood, or throwing of the blood only. Vomiting blood can be a scary and a discomforting experience for many people.

Throwing up the blood either mixed with or without stomach contents could be a sign of a serious problem such as internal injuries, organ bleeding, or organ rupture. In some cases, it could be due to a minor cause such as swallowing blood from a mouth injury or from a nosebleed. Such minor causes usually do not cause any long-term harm.

Types of vomited blood: How does the vomited blood look like?

Regurgitated blood may look brown, black, bright red, or dark red in color. Brown blood generally resembles coffee grounds when vomited, called coffee ground blood.

The color of your vomited blood can indicate the source and severity of the bleeding in your organs. For example, darker blood often occurs due to the bleeding from an upper gastrointestinal (GI) source, such as the stomach. Bright red blood is generally indicative of severe bleeding from the esophagus or stomach. The color of blood in the vomit does not always indicate the source and severity of the bleeding, but it helps the doctor to start investigation.

The amount and colour of the blood in vomit can also vary:

  • vomiting large amounts of bright red blood
  • only streaks of blood in the vomit, mixed up with stomach contents such as food
  • small pieces of blood clots, something similar to coffee grounds in the vomit

If you vomit large amounts of blood, about the size of a small cup, or if you experience dizziness or changes in breathing after the vomiting, you should call emergency immediately. This might require an urgent medical attention.

More: Blood in urine (Hematuria)

Common causes of vomiting blood: Why am I vomiting blood?

Vomiting blood can be a symptom of a minor problem or some serious health condition. When you vomit blood it means there is bleeding in your oesophagus (gullet), stomach or the small intestine (particularly the duodenum, which is the first portion of the intestine).

The most common causes of vomiting blood are listed here. They may range in severity from minor to major. It's a basic guide to give you an idea of the problem. However, you shouldn’t use it to diagnose the condition by yourself. You must contact an expert for the diagnosis and follow-up treatment.

Minor conditions causing vomiting of the blood

  • swallowing of the blood
  • swallowed foreign object that causes problem inside the body
  • tear in the esophagus due to coughing
  • Vigorous vomiting
  • esophagus irritation
  • nosebleeds

Serious causes of vomiting blood

Other common causes of vomiting blood

  • side effects of non-steroidal anti-inflammatory drug
  • pancreatitis
  • aspirin side effects
  • gastritis (stomach inflammation)
  • a blood condition, such as a reduced number of platelets in the blood, leukaemia, haemophilia or anaemia
  • severe gastro-oesophageal reflux disease (GERD)
  • esophageal varices

Vomiting of the blood in infants and young children can be caused many other conditions such as:

  • Lack of vitamin K
  • Milk allergy
  • Blood clotting problems
  • Swallowed blood or a swallowed foreign object
  • Birth defects and abnormalities

Some major causes of the vomited blood (Haematemesis) are discussed here.

Vomiting blood as a sign of colon cancer or colorectal cancer

Many cases of colorectal cancer have no symptoms or warning signs until the cancer has advanced. Vomiting can be one of these signs. However, it is important to note that vomiting can be caused by a number of other normal problems such motion sickness, unpleasant sights or smells.

If nausea and vomiting are accompanied with other symptoms such as constipation or pain, colon cancer could be the cause. When vomiting is a symptom of colon cancer, it is usually because a tumor is causing a bowel obstruction. Vomiting may be accompanied with blood depending on the severity of the blockage. With colon cancer, some patients throw up blood quite frequently. But it is usually accompanied with other conditions such as abdominal pain, changed bowel movements, constipation, etc.

Gastro-esophageal reflux disease (GORD)

Gastro-esophageal reflux disease (GORD or GERD) occurs when acid leaks out of the stomach and enter into the esophagus. Acid reflux occurs when sphincter muscles at the lower section of the esophagus relaxes at the wrong time, allowing stomach acid to move up into your esophagus.

Severe form of GORD can cause irritation and tear of the lining of your esophagus and start bleeding. A tear in the lining of esophagus due to prolonged irritation can also cause bleeding and blood-mixed vomiting.

Esophageal varices and throwing up blood

Esophageal varices are enlarged veins that develop in the walls of the lower section of the esophagus. They can cause bleeding. Usually, they don’t cause any pain.

Esophageal varices generally develop in liver diseases. You might be asked for admission in hospital of the suspected cause of vomiting with blood is esophageal varices.

The most serious cause of esophageal varices is cirrhosis.

Gastritis and vomiting blood

Gastritis is a condition characterized by inflammation of the stomach lining. Acute gastritis involves severe inflammation and usually occurs suddenly. Chronic gastritis involves long-term inflammation that can last for years if left untreated and develops gradually.

A person with gastritis may experience a burning pain in the stomach. Bleeding may occur if the inflammation causes damage to arteries in the region. Generally, gastritis is not a serious condition but it can last for years without treatment, and may ultimately cause development of ulcer or cancers in the stomach.

There are many causes of gastritis such as infection, regular use of non-steroidal anti-inflammatory painkillers, excessive use of alcohol, stress etc.

Peptic ulcers: Stomach ulcers, Duodenal ulcers

Stomach ulcers (gastric ulcers) are open sores that develop on the lining of the stomach. They can also develop in the intestine right beyond the stomach. These are called duodenal ulcers. Stomach ulcers and duodenal ulcers are together referred to as peptic ulcers.

These ulcers may cause bleeding which may also appear in the form of vomiting. Blood from a stomach ulcer or cancer may be bright red or dark brown with a grainy appearance like that of coffee grounds. It may be accompanies with a burning or gnawing sensation in the stomach travelling up to the neck and down to the belly button, or through the back.

Vomiting blood as a sign of esophageal cancer

Vomiting blood is not the main symptoms of esophageal cancer, but it eventually affects patients suffering from this type of cancer. Usually, patients experience problems such as difficulty in swallowing, which is a common sign of the tumor or cancer in esophagus. Vomiting blood only occurs if the cancer grows rapidly. The growth of esophageal cancer is not accompanied by sufficient growth of the blood vessels that supply nutrients to the tumor. Some parts of the tumor may become necrotic and start bleeding. Bleeding of the esophageal cancer is also possible during radiation therapy of the cancer.

Bleeding from the esophagus in patients with esophageal cancer is not a good sign and may indicate to progression of the disease. People who have developed an esophagotracheal fistula may have more esophageal bleeding.

Pancreatic cancer and puking blood

Sometimes, you may throw up blood due to pancreatic cancer. Pancreatic cancer begins in the tissues of your pancreas, an organ in the abdomen that lies horizontally behind the lower part of the stomach. Pancreas releases enzymes that help in digestion and hormones that help control blood sugar levels.

Nausea and vomiting occurs particularly during later stages of the pancreatic cancer, when the tumor has grown significantly large enough to block at least a part of the digestive tract (mainly the duodenum).

Blood vomiting in liver cirrhosis

Varices are enlarged and swollen blood vessels in the lining of the stomach. One of the reasons why varices develop is liver cirrhosis or alcoholic liver diseases. In cirrhosis, scarred liver tissue blocks blood flow through the liver. This increases the pressure. The increased pressure pushes back into the gut and causes the veins to inflame in the stomach.

Cirrhosis is a serious condition of liver, where normal tissue is replaced by scarred tissue. The condition progress slowly and often does not cause symptoms in the beginning. With liver gradually becoming worse, serious problems start developing. Blood in vomiting can be an indication of the advanced liver disease. Read about liver cirrhosis.

Bleeding which has not come from the gut

Sometimes, vomited blood comes from somewhere else and not from the gut. If you have had a nosebleed and then swallowed the blood, you may vomit it. Sometimes, it may be blood with coughing, which is generally not a major problem. Often, it is difficult to tell whether the blood has been vomited from the gut, or coughed up.