Esophageal Varices and Vomiting Blood: What to Know

Esophageal varices are enlarged veins in the lower food pipe. They can develop when scarring or another blockage in the liver circulation raises pressure in the portal vein system. The vein walls may be fragile, so bleeding can begin suddenly and may be heavy.

Blood may look bright red, dark red, or like coffee grounds after contact with stomach acid. Black, tarry stools can also occur when swallowed blood passes through the digestive tract. Vomiting blood has several possible causes, including ulcers and tears, so its appearance alone cannot identify the source or indicate cancer.

Call emergency services immediately if blood is being vomited, even if the bleeding seems to have stopped. Do not drive yourself. Sit upright or lie on your side while waiting, and keep the person supervised if they feel faint or drowsy.

Do not eat or drink, take aspirin or ibuprofen, or use alcohol while waiting for urgent assessment unless an emergency clinician tells you otherwise. Bring a list of medicines, especially blood thinners, and mention any liver disease, previous variceal bleeding, or vomiting episodes.

Treat any vomiting of blood as urgent. Emergency warning signs include dizziness, fainting, confusion, pale or clammy skin, a fast heartbeat, weakness, shortness of breath, or black stools. These can signal significant blood loss or shock and need immediate treatment.

In hospital, clinicians may check circulation and blood tests, give fluids or blood products when needed, and use an endoscope to find and control the bleeding. Medicines that reduce pressure in the portal system and antibiotics may also be used. Further care focuses on preventing another bleed and treating the underlying liver or circulation problem.

Ask what caused the varices, whether an endoscopy is needed, which medicines should be started or avoided, and how to recognise another bleed. If a procedure was performed, ask when follow-up treatment is due and whether screening for other enlarged veins is appropriate.