What Causes a Small Amount of Blood in Vomit or Bile?

Key takeaways:

• A large amount of blood in the vomit should be treated as a medical emergency.
• Some causes of blood in vomit are less serious than others.
• A thorough medical history and exam can help reveal the cause of blood in vomit

As unpleasant as vomiting is, it’s usually not something to worry about. But seeing blood in your vomit can be alarming – even if it’s a small amount. While it might not always signal a problem, it is important to understand what could be causing the blood in your vomit.

This article will explore potential causes of small amounts of blood in vomit or bile. It will also explore how the appearance of blood in the vomit can vary, when to consult a healthcare professional, and what can be done to address it.

When throwing up blood may be serious

Blood in vomit is often a sign of internal bleeding coming from the upper gastrointestinal (GI) tract.

Some causes include ruptured blood vessels, peptic (bleeding) ulcers, and traumatic injuries to the stomach or esophagus. These are the most serious causes of blood in vomit. They can all lead to various amounts of blood loss, from mild to severe.

Possible causes of small amounts of blood in vomit or bile

Even small amounts of blood in the vomit must be taken seriously. It should never be considered a normal finding. Although some causes of blood in vomit are benign, others (as described above) are more serious. Still, this is always treated as a medical emergency. That will remain the case until the cause can be identified.

Bleeding ulcers

Peptic ulcer disease can cause ulcers (sores) in the upper GI tract. It is the most common cause of upper GI bleeding, which leads to vomiting of blood. If you have peptic ulcers, you are likely infected with a type of bacteria known as Helicobacter pylori (H. pylori).

Another cause is excessive use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin.

Traumatic injury

Another source of blood in vomit is an injury to the abdomen, chest wall, or throat.

This type of injury can cause bleeding in the stomach and esophagus. This, in turn, can lead to vomiting blood. In rare cases, such injuries can occur as a result of a surgical procedure.

Mallory-Weiss tears

Forceful, repetitive vomiting can cause small tears in the inner lining of the esophagus. These are known as Mallory-Weiss tears and can lead to blood in vomit. Some risk factors for these tears include heavy alcohol use, gastroesophageal reflux disease (acid reflux), and eating disorders such as bulimia.

In most cases, Mallory-Weiss tears will heal on their own within a few days. To prevent them from coming back, the underlying cause must be addressed and treated.

Acute inflammation

In some cases, the esophagus and stomach lining become badly inflamed. This, in turn, can cause the underlying vessels to bleed, leading to blood in vomit.

Common causes of upper GI inflammation include severe acid reflux, heavy alcohol use, and heavy or prolonged use of NSAIDs. Acute infections such as viral gastroenteritis or food poisoning may also lead to stomach inflammation.

Causes of small amounts of blood in vomit based on specific situations

Small amounts of blood may show up in vomit due to irritants, triggers, or changes in anatomy. Be sure to familiarize yourself with some of these situations. It can help you know what to expect and what to do if you notice small amounts of blood after vomiting.

Vomiting small amounts of blood during pregnancy

Morning sickness is common during pregnancy. But repetitive vomiting due to morning sickness can cause inflammation and small tears in the esophagus. Both of these conditions can lead to blood in vomit.

Pregnancy can also lead to increased pressure in the veins. This can cause veins in the esophagus to become enlarged and potentially rupture. A less severe cause of vomiting small amounts of blood while pregnant is swallowing blood from bleeding gums. This is a common and benign symptom that can occur during pregnancy.

Vomiting small amounts of blood after drinking alcohol

Heavy alcohol consumption carries many risks, such as inflammation in the upper GI tract. Other risks include new or worsening acid reflux, and the development of Mallory-Weiss tears in the esophagus.

All of these have been associated with blood in vomit. Excessive alcohol consumption is also linked to a chronic liver disease known as cirrhosis of the liver. In patients with cirrhosis, pressure in abdominal and esophageal veins can increase. This causes them to become enlarged and potentially rupture.

Vomiting small amounts of blood and experiencing chest pain

If you’re having chest pain and are vomiting small amounts of blood, it could be due to several causes.

You could have gastroesophageal reflux disease (often called acid reflux). Or, the cause might be Mallory-Weiss tears or traumatic injuries to the esophagus or stomach. While heart attacks may have symptoms of nausea and vomiting, they are not typically associated with vomiting blood – but do not take any chances. Seek medical care as soon as possible.

Diagnosing the causes of small amounts of blood in vomit or bile

The history and physical exam are important steps in diagnosing the cause of blood in vomit. Your healthcare provider will ask many questions about your diet and lifestyle.

For instance, you’ll be asked about your alcohol use and smoking history, as well as medications you take, among other questions. Be sure to disclose any additional symptoms you may be experiencing. These symptoms can help your doctor determine a potential cause or diagnosis.

During the physical exam, your healthcare team will closely monitor your vital signs, looking for signs of blood loss. They will assess for signs of dehydration due to excessive vomiting. An abdominal exam can help reveal areas of stomach pain or the presence of any masses. A doctor or nurse may also look in your nose and mouth to see if they can identify other sources of bleeding, such as bleeding gums or nosebleeds.

Blood tests may be performed to look for clues about the cause of blood in vomit. Prolonged and chronic upper GI bleeds can lead to iron deficiency and anemia. Diagnostic studies such as endoscopies can help locate the source of upper gastrointestinal bleeds and can be both diagnostic and therapeutic. Imaging studies such as CT scans (known as CT angiography) can help identify actively bleeding vessels.

Read our guide on different types of vomit and its colors for more.

Common treatment options for small amounts of blood in vomit or bile

Blood in the vomit is always treated as a medical emergency until the underlying cause is found. While you’re having a medical workup, you’ll undergo treatment to rehydrate you and get you stabilized. Once the cause of your vomiting blood is identified, your doctor will discuss specific treatment options.

Medication

When the suspected cause of blood in vomit is an ulcer or acid reflux, medications that reduce acid production can be effective. If an H. pylori infection is identified, you’ll receive antibiotics along with acid-reducing medications.

If the blood in vomit is thought to be caused by viral gastroenteritis (often called stomach flu), anti-nausea medications may be prescribed. As a precautionary measure to help control bleeding, your doctor may advise you to stop taking aggravating medications like NAISDs and drugs that are known to thin the blood.

IV fluids

Intravenous (IV) fluids are among the first steps in treating patients who seek medical care for blood in vomit. IV fluids can prevent or reverse dehydration due to excessive vomiting.

They can also help stabilize vital signs, such as blood pressure, that may be affected by blood loss.

Lifestyle changes

If the cause of blood in your vomit is found to be inflammation, your doctor may recommend lifestyle changes.

These can clear up your current symptoms and help prevent future occurrences. If you have acid reflux, for instance, you’ll probably be advised to make dietary changes. These could include reducing spicy and acidic foods in your diet and cutting back on drinks with caffeine. Giving up smoking and drinking less alcohol will also help eliminate inflammation. Other irritants such as NSAIDs should be taken only as needed.

Surgical intervention

If the source of bleeding can’t be controlled, you may need surgery. For example, if you’re diagnosed with peptic ulcer disease that has caused a perforation or holes in your stomach, surgery may be the best option for you.

Questions to ask your doctor about small amounts of blood in vomit or bile

• What could be causing the blood in my vomit?
• There is only a small amount of blood in my vomit; is this an emergency?
• How will you diagnose the cause of the blood in my vomit?
• What will be done to treat the cause of blood in my vomit?

Frequently asked questions: small amounts of blood in vomit

If you notice any amount of blood in your vomit, you’ll undoubtedly be concerned. You will also have questions about how serious it is and what’s causing it. Below are answers to some of the most common questions asked about this health issue.

Can vomiting blood cause death?

It’s unlikely that small amounts of blood in vomit can lead to death. However, severe and large-volume blood loss can lead to shock – and that can lead to organ failure and death.

It is important to seek medical attention immediately upon noticing blood in the vomit to avoid potentially dangerous large-volume blood loss.

What foods or drinks can cause red or bloody-looking vomit?

Certain foods and drinks can cause red or bloody-looking vomit in the absence of actual blood.

For instance, if you vomit immediately after eating, it’s common for your vomit to be the color of whatever you ate. Foods containing red dye such as candies, juices, ice pops, or even naturally red foods like beets can cause red-colored vomit. Considering your diet as a potential cause for red-appearing vomit can minimize your fear and help you avoid a lengthy workup.

How can you tell if there is blood in your vomit or bile?

You can tell if there’s blood in your vomit based on appearance. Bright-red blood indicates active or very recent bleeding.

Dark brown or black vomit, or vomit that resembles coffee grounds, indicates digested blood. It’s a sign of blood that has been sitting in the digestive tract for a longer period of time.

A symptom that can’t be ignored

Blood in the vomit should never be ignored or brushed off as “probably normal.” If you ever experience this symptom, do not delay – seek medical attention immediately.

Knowing the various causes as well as the different ways blood in the vomit may appear can help guide you when giving your doctor a history. Remember that underlying causes of blood in the vomit can range from fairly benign to serious and life-threatening. Early diagnosis and treatment can make all the difference.

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. Lane Thaut, DO.

Sources

Anand, BS, “Peptic Ulcer Disease: Background, Anatomy, Pathophysiology.” Medscape.com, August 2019. emedicine.medscape.com/article/181753-overview.

DiGregorio, Alexander M. and Heidi Alvey, “Gastrointestinal Bleeding.” StatPearls, StatPearls Publishing, June 5, 2023. https://pubmed.ncbi.nlm.nih.gov/30725976/

National Institute of Diabetes and Digestive and Kidney Diseases, “Cirrhosis,” June 2023. www.niddk.nih.gov/health-information/liver-disease/cirrhosis.

Upchurch, Bennie, “Upper Gastrointestinal Bleeding (UGIB): Practice Essentials, Background, Etiology,” Medscape.com, October 19, 2019. medicine.medscape.com/article/187857-overview.