Heartburn and spitting blood: what to know

Heartburn is a burning feeling caused when stomach contents move upward into the food pipe. Blood may instead come from irritated gums, a nosebleed, the throat, the lungs, or bleeding higher in the digestive tract. Acid reflux can irritate the lining, while gastritis or a peptic ulcer can bleed. A hiatus hernia can worsen reflux. The appearance matters: bright-red streaks mixed with saliva differs from dark material or vomit resembling coffee grounds. Heartburn alone does not identify the source of blood.

Stop smoking and avoid alcohol until assessed. Do not take aspirin or anti-inflammatory painkillers unless a clinician has specifically advised them. Note whether the blood followed coughing, vomiting, brushing your teeth, or a nosebleed, and record its colour and amount. A clinician may examine your mouth and throat and ask about medicines, reflux symptoms, black stools, dizziness, and abdominal pain. Do not start acid reflux medication to mask bleeding without professional advice.

Seek emergency care now for more than a small streak, repeated bleeding, vomiting blood, black or tarry stools, faintness, confusion, severe weakness, chest pain, breathing trouble, or severe abdominal pain. Get same-day medical advice even if the blood has stopped, especially when it is unexplained or you take blood thinners. While waiting, sit upright and avoid food or drink if vomiting is continuing.

Could the blood be coming from my mouth, lungs, or digestive tract? Which medicines should I pause or avoid? Do my symptoms fit acid reflux, gastritis, or an ulcer? What changes should send me to emergency care?