Hematemesis is an extremely dangerous medical condition where the afflicted patient expels a significant amount of blood in the form of vomit. The blood in the patients vomit usually originates from the upper gastrointestinal tract (oesophagus, stomach, or intestines). However, the bloods color may not always be red. Other times, it can have the appearance and color of ground coffee (slightly brown). Either way, hematemesis is a very serious condition and should not be taken lightly. The patient suffering from hematemesis may experience blood loss and can lead to shock, which is why medical assistance should always be sought.

Possible Causes of Hematemesis:

Hematemesis may be brought on by a number of different reasons, some more serious than others. However, when a person suffers from hematemesis, self-diagnosis should never be done or even attempted. He or she should be brought to the hospital right away for proper diagnosis and treatment. Immediate diagnosis and treatment of the cause of hematemesis is of utmost importance.

1. Nose Bleeds

There are instances when the person suffering from hematemesis may only think he is vomiting blood, when in reality, he is actually experiencing a nose bleed. It is possible for the blood originating from the nose to trickle down towards the back of the throat or oesophagus, causing the persons natural gag reflex to kick in, making him or her vomit blood. This can easily and often be confused with hemoptysis, which is the coughing up of blood; but that is a different condition altogether.

2. Excessive Vomiting

Another cause of hematemesis is excessive, violent, or continuous vomiting. When a person vomits violently over a prolonged period of time, it is possible for small tears or lacerations to develop in the oesophagus. This is common in people who have been experiencing a virulent stomach bug. Tears and lacerations in the oesophagus can also be caused by ulcers or certain types of cancers (both malignant and benign). In cases like these, the doctor may decide to insert a scope down the patients throat to determine the source of the bleed and locate any tears.

3. Bleeding Peptic Ulcer

Bleeding Peptic Ulcer is caused by Helicobacter pylori, a bacteria strain that can cause an increase in the acid production in the patients stomach. Stomach pain is the initial symptom of bleeding peptic ulcer, followed by loss of appetite, weight loss, and eventually, hematemesis. Bleeding peptic ulcer, if diagnosed and treated early, can easily be treated with antacids or H2 antagonists, especially in younger patients. In advanced and severe cases, however, surgery may be required.

4. Aspirin

It is a little known fact that aspirin is one of the primary causes of hematemesis or the vomiting of blood. While aspirin has been proven to reduce the risk for heart conditions by almost ten percent, studies show that daily intake of aspirin is one of the primary causes of stomach bleeding. Aspirin is a blood thinner that can help prevent and eliminate clotting, which is why it is so helpful to patients that have previously suffered from heart attacks and strokes or are genetically predisposed to develop such conditions. However, it is the same blood thinning properties of aspirin that can lead to hematemesis and blood in the stool. Aspirin can irritate the stomach lining which causes internal bleeding, making it one of the leading causes of hematemesis, blood in the stool, and other gastrointestinal conditions.

5. Mallory-Weiss Syndrome

The Mallory-Weiss Syndrome, named after G. Kenneth Mallory and Soma Weiss who first diagnosed the condition, is also known as gastro-oesophageal laceration syndrome. It refers to bleeding from tears or lacerations (Mallory-Weiss tears) at the junction of the stomach and oesophagus. The condition is usually caused by eating disorders and excessive alcoholism.

6. Radiation Poisoning

Radiation poisoning is caused by extended exposure to excessive amounts of ionizing radiation. In small doses, radiation poisoning can cause symptoms such as nausea, hematemesis, and the lowering of the patients blood count. Treatment for radiation poisoning includes antibiotics, stem cell transplants, and other blood products.

7. The Ingestion of Caustic or Corrosive Substances

Hematemesis can also be caused by the ingestion of caustic or corrosive substances such as household cleaning products and other alkaline or acidic products.

8. Oesophageal Varices

Oesophageal varices are swollen, enlarged veins in the lower third area of the oesophagus that can cause hematemesis. This is most commonly seen in patients with severe liver diseases. Oesophageal varices are caused blood flow to the liver is blocked or hindered by a clot or scar tissue near or around the liver. The blood tries to look for another way to pass through, and finds itself flowing into blood vessels that are not designed to carry huge amounts of blood. This can cause the vessels to swell and in extreme cases, rupture, causing the patient to expel the blood in the form of vomit. Oesophageal varices are treatable by drugs and certain medical procedures.

9. Alcoholic Hepatitis

Alcoholic hepatitis is caused by the excessive intake of large amounts of alcohol. It is associated with the early stages of alcoholic liver disease and may eventually lead to cirrhosis. Alcoholic hepatitis and its symptoms, such as hematemesis and liver swelling, are usually seen in heavy drinkers who have been ingesting alcohol over a long period of time. However, it is important to note that not all heavy drinkers develop alcoholic hepatitis, and the condition can also appear in people who do not drink heavily. Patients who are diagnosed with alcoholic hepatitis should refrain from drinking immediately because continued ingestion of alcohol can lead to extreme liver failure and even death.

These are only a few of the possible causes of hematemesis. Other possible causes include:

  • Pancreatic ulcer
  • Cancer of the oesophagus, stomach, or intestines
  • Liver cirrhosis
  • Gastritis (inflamed stomach) or gastric erosion
  • Portal hypertension (high blood pressure in the portal blood vessels)
  • Use of NSAIDs
  • Dieulafoys Syndrome
  • Acute liver failure
  • Swallowing of coughed up blood (not to be confused with coughing up blood)
  • Oesophagitis (inflammation of the oesophagus)


If the patient suffering from hematemesis has lost a huge amount of blood, blood transfusion may be required to bring the patients blood volume back to normal. However, the first step should be diagnosing the cause of hematemesis. A range of diagnostic tests should be performed when the patient is first brought to the doctor. After a diagnosis is reached, the doctor can then make recommendations for treatment which include, but are not limited to, surgery and medication. The doctors may choose to keep the patient in the hospital until he or she stops vomiting blood.

If the hematemesis is extreme, stopping the bleeding is the doctors first priority. An oesophagogastroduodenoscopy may be performed to locate the cause of the bleeding. This refers to the insertion of an endoscope (a tube with a lens or camera) to see the patients gastrointestinal tract.