Is Black Vomit Serious? Causes & What to Do

Key Takeaways:

• Black vomit is often a sign of stomach or gastrointestinal (GI) bleeding, which can result from conditions like an ulcer or liver disease. Because black vomit can be a serious symptom, it is important to see your doctor as soon as possible.
• The look and texture of black vomit can hint at the cause. A coffee-ground texture could mean GI bleeding, whereas a watery consistency could indicate a liver condition or poisoning.
• Immediate medical care is a must if black vomit is accompanied by other symptoms like stomach pain, dizziness, passing out, or black stools. These may indicate an urgent, and possibly life-threatening, condition.

Seeing black-colored vomit can be alarming – and it’s not a symptom to be ignored. Black vomit is often a sign of a serious underlying health issue, like internal bleeding, and its color and texture can offer some clues about its cause. Black vomit typically signals blood in the stomach that has been partially digested; this partial digestion is what gives it a dark color.

Understanding the possible causes of black vomit can help you decide what to do and when to get medical help. In this article, we cover the possible causes of black vomit, when to seek medical attention, and some available treatments.

When to see a doctor about black vomit

If you’re vomiting and notice its color is dark brown or black, this is cause for concern. Black vomit can be a sign of internal bleeding from your stomach or intestines.

You may have other symptoms too, such as dizziness, fainting, severe pain in your stomach and abdominal area, or black stools. Any of these heighten the urgency of a medical evaluation. If you are experiencing black vomit (whether you have other symptoms or not), seek medical care immediately.

Common causes of black vomit based on appearance or when it occurs

Knowing the possible causes of black vomit can give you an idea of how serious your condition is and what to do next. Following are some common causes of black vomit based on appearance and symptoms.

Black vomit with coffee grounds texture

Black vomit that resembles coffee grounds can be a symptom of internal bleeding; specifically bleeding in the upper gastrointestinal (GI) tract. The GI tract is a long, twisting tube that runs from the mouth to the anus. It is divided into upper and lower sections known as tracts. The upper GI tract includes the mouth, esophagus (food tube), stomach, and the first part of the small intestine (the duodenum). The lower GI tract is made up of the small and large intestines and the anus.

Black vomit originates with blood in the stomach. This is likely caused by a stomach ulcer or severe inflammation of the stomach (gastritis). Another possible cause is enlarged varicose veins in the esophagus, which bleed and send blood down into the stomach. When blood in the stomach interacts with stomach acid, the blood will break down and darken in color.

Thus, your vomit will be black (or very dark brown) and will resemble coffee grounds. If this happens to you, see your doctor immediately or go to the ER. You’ll need to be evaluated to determine what’s causing the bleeding and to prevent further complications.

Black, watery vomit

If vomit has a thin, black, watery appearance, it could signal bleeding in the upper GI tract. This is most common among people with liver disease; specifically, those whose internal bleeding occurs due to complications like portal hypertension (increased pressure in the major vein that runs through the liver). Black, watery vomit can also be caused by ingestion of a poisonous substance like arsenic or other heavy metals.

Black, watery vomit may also result from ingesting bismuth, which is found in Pepto-Bismol and other over-the-counter remedies for an upset stomach. Although bismuth is nontoxic, it can cause saliva, stomach contents, or stool to take on a black appearance. This reaction is harmless – but it’s a good idea to contact your doctor anyway to be sure it isn’t masking a more serious cause of black vomit.

Black vomit with a mucous texture

Black vomit that contains mucus could be a sign of an irritation or injury in your stomach lining. Gastritis is one condition that may cause this type of vomiting. When you have gastritis, your inflamed stomach lining produces mucus in an attempt to protect the lining.

If you see mucus combined with blood, this could be a sign of a serious condition such as a perforated ulcer. This condition causes a hole in the stomach, which allows stomach contents and acid to escape into the abdominal cavity. A perforated ulcer is usually accompanied by sudden severe pain in the upper abdomen. In many cases, it requires immediate surgery.

Vomit with black flakes or specks

Vomit containing black specks or flakes is often less serious than the black vomit discussed so far in this article – but it is still concerning.

These black specks could mean minor GI bleeding or blood that has clotted into small particles. Ingesting certain substances, such as activated charcoal (used in treating some types of poisoning), can also cause black specks in vomit. If vomit that contains black specks is accompanied by stomach pain, and/or the vomiting won’t stop, you should definitely seek medical care.

Black vomit after drinking

Black vomit after alcohol consumption could be a sign of serious internal bleeding. Regularly drinking alcohol can lead to stomach inflammation, liver disease, or varicose veins of the esophagus – all of which can cause GI bleeding.

If you’ve been drinking and notice that your vomit is very dark or black, you should get medical care immediately. It could possibly indicate a life-threatening condition.

Black vomit accompanied by black stool or diarrhea

When black vomit occurs along with black, tarry stools (melena), this nearly always points to serious upper GI bleeding. The presence of both black vomit and black stools means that blood is passing all the way through your digestive system.

Possible causes include a bleeding ulcer, severe liver disease, or even cancer. Because this is an urgent situation, please seek medical attention right away.

Read our guide on vomit types and colors for more.

Diagnostic and treatment options for black vomit

Treatment for black vomit depends on the underlying cause. Here are some possible diagnostic methods and treatments based on the most common causes of black vomit:

Endoscopy

To find the source of bleeding (and attempt to stop it), doctors often perform an endoscopy. This procedure involves inserting a scope down the throat into the stomach so the doctor can see the inside of the GI tract.

When the source of the bleeding is located (such as from a bleeding ulcer or varicose veins in the esophagus), the doctor can usually stop the bleeding by applying clips to a bleeding blood vessel or cauterizing the bleeding area.

Medications

Your doctor may prescribe medications such as proton pump inhibitors (PPIs) to reduce stomach acid so that an ulcer or area of bleeding has a chance to heal.

In cases of liver disease leading to conditions like portal hypertension or scarring of the liver (cirrhosis), other medications may be required.

Surgery

In the case of a perforated ulcer or severe GI bleeding, surgery may be necessary. This will enable the doctor to repair the damaged area and take steps to prevent further bleeding.

Questions to ask your doctor about black vomit

If you are experiencing black vomit, having a clear understanding of your condition is important. Here are a few questions to ask your doctor:

1. What is the most likely cause of my black vomit?
2. Do I need any specific tests to confirm the diagnosis?
3. What are the treatment options for my condition?
4. How urgent is the need for treatment, and what can I do in the meantime?

Frequently asked questions: black vomit

Is black vomit a common sign of the end of someone’s life?

Black vomit can occur in end-stage liver disease or other terminal conditions that involve severe internal bleeding.

Yet even though it can be a sign of advanced illness, black vomit does not necessarily mean that death is about to happen. It is, however, a serious symptom that requires prompt medical care.

Is black vomit a sign of a bowel obstruction?

Black vomit is typically not caused by a bowel obstruction. Rather, a bowel obstruction may be the cause of other symptoms such as abdominal pain, bloating, and the inability to pass gas or stool.

Vomit that occurs from a bowel obstruction usually appears dark green or brownish but is not typically black unless there is bleeding involved.

Final thoughts

Black vomit can be a sign of a serious underlying condition, especially when it is the result of bleeding in your esophagus, stomach, or intestines. While some causes may be less severe, it’s essential to recognize when you should get medical care. If you or someone you know is experiencing black vomit, consult a healthcare provider as soon as possible to determine the cause and get appropriate treatment.

General Medicine follows a strict editorial process, including using real experts to write our articles, vetted primary sources, fact-checking, a secondary medical review, and updates as necessary. This article was medically reviewed and fact checked by Dr. Adam Carewe, MD.

Sources

American College of Gastroenterology. “Peptic Ulcer Disease.” American College of Gastroenterology, March 7, 2024. https://gi.org/topics/peptic-ulcer-disease

American Liver Foundation. “Cirrhosis: Severe Scarring of the Liver.” American Liver Foundation, April 2021. https://liverfoundation.org/about-your-liver/how-liver-diseases-progress/cirrhosis-severe-scarring

Centers for Disease Control and Prevention. “About Alcohol Use,” CDC, U.S. Department of Health and Human Services, May 15, 2024. www.cdc.gov/alcohol/about-alcohol-use/index.html

National Institute of Diabetes and Digestive and Kidney Diseases. “Gastrointestinal Bleeding.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services, July 2024. www.niddk.nih.gov/health-information/digestive-diseases/gastrointestinal-bleeding

National Institute of Diabetes and Digestive and Kidney Diseases. “Upper GI Endoscopy.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services, October 2023. www.niddk.nih.gov/health-information/diagnostic-tests/upper-gi-endoscopy

Veterans Health Administration. “Gastrointestinal Bleeding: Symptoms, Diagnosis, and Treatment.” Veterans Health Library, U.S. Department of Veterans Affairs, 2024. www.veteranshealthlibrary.va.gov/Encyclopedia/3,40442