Haematemesis (vomiting blood)

Worried about your symptoms? Talk to a doctor.

Haematemesis is the medical word for vomiting blood. It's a sign of bleeding somewhere in your upper gut, usually your gullet (oesophagus), stomach or the first part of your small intestine (duodenum), and it always needs urgent medical assessment.

What is haematemesis?

What are the common causes of haematemesis?

Common causes include:

A stomach or duodenal ulcer: A small break in the lining of your stomach or the first part of your gut, often caused by a bacterial infection called Helicobacter pylori, or by anti-inflammatory painkillers or aspirin
Alcohol-related liver disease: Scarring of the liver can raise the pressure in nearby veins, causing swollen, fragile veins (varices) in the gullet or stomach that can bleed heavily
A tear in the lining of the gullet (a Mallory-Weiss tear): Caused by forceful or repeated vomiting, retching, or violent coughing
Inflammation of the gullet (oesophagitis): Often due to acid reflux
Inflammation of the stomach lining (gastritis): With similar causes to a stomach ulcer.

Less common causes include:

Cancer: Of the stomach or gullet
Blood clotting conditions: Such as haemophilia
Medicines: Including aspirin, anti-inflammatory painkillers and anticoagulants/DOACs/NOACs (blood-thinning medicines) such as warfarin, edoxaban and rivaroxaban. These don't usually cause the bleeding on their own, but can make bleeding worse if you already have a problem such as an ulcer
Poisoning: Or rare infections or injuries affecting the gut.

Sometimes blood that's vomited hasn't come from your gut at all. For example, you can swallow blood from a nosebleed and then bring it back up.

Are there different types of haematemesis?

Haematemesis is usually described by the colour and amount of blood, which gives a clue as to how recent and serious the bleeding is.

Dark blood, or 'coffee-ground' vomit: This suggests a smaller or slower bleed because when the blood has been in contact with stomach acid for a while it can turn a dark brown or black colour.
A large amount of bright red blood: This suggests fresh, fast and potentially significant bleeding.

Vomiting blood can also happen together with melaena, which is when your stools become very dark, black and tar-like from digested blood further down the gut. Having both together suggests a significant amount of bleeding.

How is haematemesis diagnosed?

A doctor will ask about the bleeding, such as how much there was and what it looked like, along with any other symptoms, and will examine you. Checking your pulse and blood pressure helps them judge how much blood you may have lost and how serious the situation is.

They're likely to arrange:

Blood tests: To check how much blood you may have lost, whether you need a transfusion, and how well your liver is working.
A gastroscopy (endoscopy): Where a thin, flexible tube with a light and camera is passed down your gullet into your stomach and duodenum. This allows doctors to see directly where the bleeding is coming from, and sometimes to treat it at the same time.

How is haematemesis treated?

Treatment happens in hospital and depends on how much blood you've lost and what's causing the bleeding.

Fluids or a blood transfusion: This is given through a drip if you've lost a significant amount of blood.
Treatment during a gastroscopy: This involves using instruments passed through the endoscope to stop the bleeding, if needed – but many bleeds settle by themselves without this.
Emergency surgery: This is used in the small number of cases where bleeding is severe and doesn’t stop with other treatments.

Once the bleeding is under control, further treatment targets the underlying cause, such as medicines to reduce stomach acid for an ulcer, antibiotics if a H. pylori infection is found, or treatment for liver disease if varices are responsible.

When should I see a doctor?

Vomiting blood should never be managed at home. Call 999 or go straight to your nearest A&E if you or your child vomit blood and also have any of the following:

feeling generally unwell, confused, faint or dizzy
rapid or shallow breathing
cold, clammy or pale skin
abdominal pain
black, tar-like stools (melaena).

If you've vomited blood but have now stopped and have none of these other symptoms, ask for an urgent GP appointment, or call 111 or use 111 online. Because bleeding that seems to have settled can restart or become severe without warning, other sources recommend treating any episode of vomiting blood as a reason for emergency assessment, so if you're at all unsure, it's safest to seek emergency help.

FAQs

Does vomiting blood always mean I need to go to hospital?

Yes. Vomiting blood should always be assessed by a medical professional, even if it seems to have stopped and you feel otherwise well. In many cases, the bleeding settles quickly, but it can occasionally become severe very suddenly, so it's never something to manage at home.
What's the difference between bright red blood and 'coffee-ground' vomit?

Bright red blood suggests a fast, fresh bleed, while dark, coffee-ground-coloured vomit suggests an older or slower bleed that has been altered by stomach acid. Both need urgent medical assessment, whatever the colour.
What is melaena, and how does it relate to vomiting blood?

Melaena is the medical term for very dark, black, tar-like stools caused by digested blood. Vomiting blood and melaena often happen together, and having both suggests a significant amount of bleeding into the gut.
Can vomiting blood be caused by something other than my stomach or gullet?

Yes. Sometimes blood that's swallowed from elsewhere, such as from a nosebleed or bleeding gums, can be vomited back up. It can also be difficult to tell vomited blood apart from blood that's been coughed up from the lungs.
Will I definitely need surgery if I vomit blood?

No. Most bleeding settles by itself or can be treated during a gastroscopy. Surgery is only needed in a small number of cases where bleeding is severe and does not respond to other treatments.
Can medicines make vomiting blood worse?

Yes. Medicines such as aspirin, anti-inflammatory painkillers, and anticoagulants/DOACs/NOACs (blood-thinning medicines) such as warfarin, edoxaban and rivaroxaban, don't usually cause bleeding by themselves, but they can make it worse if you already have a problem such as an ulcer.
Always tell medical staff about any medicines you take, and consider wearing a medical alert bracelet or necklace when you're on blood-thinning medicines.