Hematemesis refers to the presence of blood in your vomit or vomiting of  pure blood that originates in upper part of your gastrointestinal tract. It needs to be differentiated from spitting blood mixed saliva which arises from teeth, mouth and throat. It also need to be differentiated from swallowed blood from nose bleed that is subsequently vomited.

Blood in the vomitus may be of bright red, or black or dark brown (coffee grounds) colors. A bright red blood signifies recent and major bleeding. While dark brown color signifies old blood. When blood comes in contact with gastric juice for a while, it turns from red to coffee ground to black. Sometime it may be difficult to differentiate if the primary problem is coughing up blood or vomiting of blood because when you have massive hemoptysis, you may swallow some of the blood only to vomit later as dark blood. When you have a major bleeding causing hematemesis, some of that blood also passes down the your gastrointestinal tract and cause dark tarry stool called malena.

Vomiting blood, after ruling out abovementioned situations, is a medical emergency that can be life threatening and needs emergent medical care.

Causes

Hematemesis is caused by the disorders of the esophagus and stomach.

Esophageal conditions:

• Esophagitis – inflammation of esophagus that causes erosion of the lining of esophagus. Gastroesophageal reflux, certain medicines, accidental ingestion of corrosive agent  and heavy alcohol consumption are  common causes of esophagitis.
• Esophageal varices – abnormal dilatation of blood vessel in lower esophagus from severe liver disease. It is the most common cause of massive hematemesis.
• Cancer of the esophagus.
• Mallory – Weiss tear – tears in the mucosa of the esophagus due to repeated vigorous vomiting.

Conditions of the stomach:

• Acute and chronic gastritis- same mechanism and causes as esophagitis.
• Stomach cancer.
• Peptic ulcer disease like gastric ulcer and duodenal ulcer.
• Erosion of gastric mucosa – Overuse of nonsteroidal anti-inflammatory drugs, exposure to corrosive agents.
• Stomach varices – same mechanism and cause as esophageal varices.

Accidental injury to the esophageal or gastric mucosa during endoscopy, or transesophageal echocardiography can also cause significant bleeding.

Treatment options

Treatment of hematemesis depends on the severity of blood loss and underlying cause of the bleeding. If you vomit small amounts of blood, you need to seek immediate care but it may not be life threatening and could be managed on non-emergent basis. You will need endoscopy and other tests to identify the underlying disease. If the blood loss is severe, your life might be in danger. You will need to be hospitalised and require intravenous fluids, blood transfusion and endoscopy to find the cause of bleeding and stop it. Sometimes, you may need surgery to stop or prevent future bleeding.

When to seek medical care

• Vomiting of blood is a medical emergency, so seek the medical care immediately.
• Following symptoms suggest life-threatening bleeding and needs emergency visit immediately.
  • fast breathing.
  • fainting.
  • rapid but feeble pulse.
  • altered level of consciousness.
  • decreased urine output.
  • dizziness upon standing.