Black vomit: what it can mean

Blood that remains in the stomach can be changed by digestive juices, making vomit look dark brown or like damp coffee grounds. Bleeding may arise in the food pipe, stomach, or upper intestine. Forceful vomiting can irritate these tissues. Black foods, supplements, or medicines can also darken vomit, but colour alone cannot safely distinguish these explanations. Food poisoning and gastroenteritis may cause repeated retching; gallstones, migraine, and pancreatitis can add nausea or abdominal pain. A clinician needs to consider the full picture, including stool colour and medicines.

Seek urgent medical care now rather than watching black vomit at home. Do not eat, drink alcohol, or take aspirin or anti-inflammatory painkillers unless a clinician directs you. If you are awake and not actively vomiting, only take small sips of water until advised. Keep the container or a photograph, and bring a list of medicines. If you feel faint, lie on your side and have someone stay with you.

Call emergency services immediately for fainting, marked dizziness, confusion, pale or clammy skin, rapid breathing, severe pain, repeated vomiting, black stools, or difficulty staying awake. Treat any black or coffee-ground vomit as urgent, even if the person feels somewhat better afterward. Do not drive if weak, dizzy, or bleeding may be continuing.

Ask whether the appearance suggests bleeding, what tests or examination are needed, and how to manage medicines that affect bleeding. Describe the colour and texture, when it started, the amount, associated pain, stool colour, and any recent retching or nosebleed.