Heartburn and throwing up blood: what to know

Blood may look bright red, dark brown, or like coffee grounds. It can come from irritation or a tear in the food pipe after forceful retching, inflammation of the stomach lining, or a bleeding peptic ulcer. Acid reflux can coexist with these problems, but heartburn alone does not explain away blood. Do not assume the bleeding is caused by reflux, and do not try to diagnose the source from its colour.

Stop eating until you have received medical advice, and take small sips of water only if you are fully alert and not actively vomiting. Avoid alcohol, aspirin, ibuprofen, and other anti-inflammatory pain medicines unless a clinician has specifically told you to take them. Do not drive if you feel faint. Note the amount and appearance of blood, your medicines, and whether you have black stools, abdominal pain, or repeated vomiting. Bring medication packets to the assessment.

Call emergency services immediately for fainting, confusion, severe weakness, fast breathing, clammy skin, severe chest or abdominal pain, or continued vomiting of blood. Emergency assessment is also needed for black, tar-like stools or signs of dehydration. Even if the bleeding has stopped and you feel better, arrange urgent same-day care because internal bleeding can recur or be hidden.

Ask what may have caused the bleeding, whether you need blood tests or a camera examination, which medicines to stop, and how to manage your heartburn safely while the cause is being checked.