Vomiting blood (hematemesis) is the regurgitation of stomach contents mixed with blood, or the regurgitation of blood only. Blood in vomit generally comes from an upper gastrointestinal (GI) source, such as your stomach.

In some cases, minor causes may trigger vomiting blood, such as swallowing blood from a mouth injury or a nosebleed. These situations will likely not cause any long-term harm.

Vomiting blood may also be caused by more serious conditions that can be a medical emergency, such as:

The color of vomited blood may help indicate to your doctor the source and severity of the bleeding. Regurgitated blood may appear:

Bright red blood often indicates an acute bleeding episode in your esophagus or stomach. It may represent a fast-bleeding source.

Darker-colored blood means the blood has been in your GI tract for a few hours. It usually represents a slower and steadier source of bleeding.

If possible, take a picture of the vomit with blood to show your doctor.

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Illustration: Sophia Smith

Call your doctor immediately or go to the ER right away if you vomit any amount of blood, especially if it follows an injury. Blood in vomit can be due to any number of causes, from mild to life threatening. It can be difficult to tell the source of the bleeding without a medical exam.

Vomiting blood caused by excessive bleeding can cause shock due to internal GI bleeding. Common symptoms of shock include:

If not treated immediately, shock can lead to irreversible organ dysfunction, multi-organ failure, and death.

If you experience any symptoms of shock, have someone take you to the ER or call 911.

Some people vomit blood after drinking alcoholic beverages. You may be more likely to throw up after drinking alcohol if you:

  • drink on an empty stomach
  • smoke cigarettes
  • take an antidepressant or antipsychotic medication

Alcohol use disorder can also lead to more serious chronic conditions that cause vomiting blood, such as alcohol-related liver disease and esophageal varices. Symptoms such as blood in vomit usually do not appear until the liver has been severely damaged.

There are many causes of vomiting blood that range in severity from minor to major. They are normally the result of an injury, illness, or medication use.

Common causes of vomiting blood include:

Less common and more serious causes include:

All instances of vomiting blood should be reported to your doctor.

To diagnose the cause for blood in your vomit, your doctor will begin by asking questions about your symptoms and whether or not you were recently injured.

Your doctor will likely perform an upper endoscopy to look inside your GI tract while you’re sedated.

They will place a small, flexible tube called an endoscope into your mouth and down into your stomach and small intestine. A fiber optic camera in the tube allows your doctor to see the contents of your stomach and examine you internally for any sources of bleeding.

Your doctor may also order a blood test to check your complete blood count. This helps to assess the amount of blood lost.

If your doctor suspects bleeding is due to another condition such as cancer, they may order imaging tests to look inside your body. These scans reveal atypical characteristics in your body, such as ruptured organs or atypical growths, and may include:

Your doctor my perform a biopsy of suspicious tissue as well as other tests based on the condition they suspect may be causing you to vomit blood.

Depending on the cause, vomiting blood may cause additional health complications.

Anemia is one complication of excessive bleeding. It’s a deficiency of healthy red blood cells. It occurs particularly when blood loss is rapid and sudden.

However, people with conditions that progress slowly, such as gastritis, or people with chronic NSAID use may develop anemia over several weeks to months. In this case, anemia may remain without symptoms until their hemoglobin, or blood count, is very low.

Vomiting blood can also lead to shock, which can be fatal and requires immediate medical attention.

Depending on the amount of blood lost, you may need a blood transfusion. A blood transfusion replaces your lost blood with donor blood. The blood is sent into your vein through an intravenous (IV) line. You might also require fluid through an IV to rehydrate your body.

Depending on the cause, your doctor may prescribe medication to stop the vomiting or to decrease stomach acid. If you have an ulcer, your doctor will prescribe medications to treat it.

In more severe cases of upper GI bleeding, your doctor may refer you to a gastroenterologist.

The gastroenterologist may perform an upper endoscopy to diagnose and treat the source of bleeding. In severe cases, such as stomach or bowel perforation, surgery may be needed.