Blood in vomit: possible causes and what to do

Call emergency services or go to an emergency department now, even if the bleeding appears to have stopped.

Vomited blood is called haematemesis. It may be bright red, dark red, streaked through vomit, or resemble brown-black coffee grounds after contact with stomach acid. A nosebleed or bleeding from the mouth can sometimes be swallowed and later vomited, but bleeding from the digestive tract must be excluded.

Possible causes include a stomach or duodenal ulcer, inflammation of the stomach lining, a tear after forceful retching, or enlarged veins in the oesophagus. Oesophageal cancer and stomach cancer can also present with vomiting blood. The appearance alone cannot identify the source or severity.

Do not eat or drink while arranging emergency help, because an urgent procedure may be needed. Sit upright if possible; if you feel faint, lie on your side where you cannot fall. Do not drive yourself. Ask someone to stay with you and bring your medicines or an up-to-date medication list.

Tell the clinical team about blood thinners, aspirin, anti-inflammatory painkillers, liver disease, ulcers, recent repeated vomiting, alcohol use and any recent nose or mouth bleeding. If safe, a photo of the vomit can help describe its colour and amount; do not delay leaving to take one.

Any vomiting of blood needs emergency assessment. Call emergency services immediately if there is heavy or repeated bleeding, fainting, confusion, severe weakness, breathlessness, clammy or pale skin, a fast heartbeat, severe abdominal or chest pain, or black tar-like stools. These signs can accompany significant blood loss.

You can ask where the bleeding may be coming from, which blood tests or scans are needed, whether an endoscopy is appropriate, and whether any regular medicines should be paused or changed. Also ask what warning signs should prompt another emergency visit after discharge.