Vomiting Up Stomach Acid or Bile: Causes & When It’s Serious

Key takeaways:

• Vomiting up stomach acid or bile can be caused by a viral infection like the stomach flu. It may also be caused by acid reflux, pancreatitis, food poisoning, vomiting on an empty stomach, and intestinal blockages.
• Vomiting stomach acid or bile usually isn’t cause for concern unless it becomes chronic.
• Frequent vomiting that makes it difficult to keep down fluids or vomiting accompanied by bleeding, severe pain, high fever, and weight loss may be a sign of something more serious.

No one enjoys the sensation of vomiting, and its appearance can sometimes be startling. In addition to the food contents from recent meals, you may notice that you have vomited up bile, a yellow or green-colored substance produced in the liver that helps with digestion.

There are multiple causes of vomiting stomach acid or bile, some of which can be treated at home and others that are more serious. Some of these causes may require more urgent evaluation from a healthcare professional or possibly in the emergency department.

Common causes of vomiting stomach acid or bile

Many factors may cause you to vomit stomach acid or bile. Both the contents of vomit and how frequently or how long symptoms have been occurring can point to the underlying culprit.

A healthcare provider can analyze the history leading up to your symptoms as well as vital signs and findings from physical exams and laboratory tests. The following are some of the most common causes of vomiting stomach acid or bile.

Viral gastroenteritis

The most common cause of vomiting stomach acid or bile is viral gastroenteritis, or the stomach flu, which is an infection that causes inflammation of the stomach and intestines.

It’s often caused by viruses that directly affect the stomach and intestines, but viral gastroenteritis can also occur after a common cold or other viral infection. Multiple viruses can cause viral gastroenteritis, including rotaviruses, adenovirus, norovirus, and more.

In cases of viral gastroenteritis, your symptoms will typically improve over time without any medications. Your risk of developing viral gastroenteritis is higher if you are exposed to other individuals who have been experiencing symptoms or shared food or drink with someone who is experiencing symptoms.

Other factors that may increase your risk of developing viral gastroenteritis include travel, consuming contaminated foods or liquids, and time of the year. In some cases, gastroenteritis may also be caused by bacterial infection. In this case, antibiotic treatment is likely necessary to resolve your symptoms.

Pancreatitis

Pancreatitis is inflammation of the pancreas. Although it can cause vomiting, it also tends to cause abdominal pain in your upper-right abdomen, which is where your pancreas is located. Pancreatitis can occur for a variety of reasons, including anatomical or mechanical issues – such as gallstones – as well as toxins like alcohol.

Metabolic factors, medications, infection, trauma, genetics, or even congenital issues can also cause the condition. You are at increased risk of vomiting bile if your pancreatitis is caused by gallstones or other abnormalities of the biliary system, which includes the gallbladder and liver.

If pancreatitis goes untreated, it can lead to life-threatening complications, including pancreatic abscess formation, tissue death of the pancreas, or multi-organ failure.

Mesenteric ischemia

Mesenteric ischemia is defined as decreased blood flow to the small and large intestines. This decreased blood flow can occur for multiple reasons, including blockages in or narrowing of the arteries and veins.

Mesenteric ischemia can be acute or chronic. Acute mesenteric ischemia is a sudden onset of decreased blood flow to the small intestine, which is often caused by obstructions like blood clots. People with acute mesenteric ischemia may experience sudden stomach pain, nausea, and vomiting. Chronic mesenteric ischemia usually develops gradually, typically because a person’s mesenteric arteries begin to narrow over time.

Vomiting caused by mesenteric ischemia, particularly when it’s acute, will likely require treatment, including IV hydration, pain medications, and possibly blood-thinning medications.

Acid or bile reflux

Medical conditions like gastroesophageal reflux disease (GERD), also known as acid reflux, may cause nausea and vomiting.

Because acid reflux occurs when stomach acid backs up into your esophagus, it may also cause you to vomit more acid than you otherwise might. Bile reflux is a similar but separate condition that occurs when bile from your liver backs up into your stomach and esophagus. It can also lead to vomiting and may occur alongside acid reflux in some cases.

Vomiting on an empty stomach

When you vomit without food in your stomach, you may be more likely to throw up larger amounts of stomach acid.

Whether caused by an infection like viral gastroenteritis or another culprit, such as food poisoning, this sort of vomit may be greenish-yellow and stickier than usual.

Causes of vomiting stomach acid or bile in different situations

In addition to the multiple causes of vomiting that are described above, there are other situations and specific scenarios in which you experience symptoms.

At specific times of the day

You may notice that you experience symptoms consistently at specific times of the day. If your vomiting is caused by acid reflux, for example, you might experience symptoms more frequently in the morning than at other times of the day. If this is true, it may be helpful to create a log or diary to identify which factors correlate with the times you are experiencing symptoms.

In addition to the times that your symptoms are occurring, take note of the volume and frequency of your vomit. It also helps to log other symptoms, changes in diet, recent increases in stress, or any other factors that you find relevant. Discuss these patterns with your primary care provider to see if there is an identifiable underlying cause.

During pregnancy

Pregnancy is another scenario in which you may experience vomiting, including vomiting stomach acid.

You may also notice related symptoms like nausea or diarrhea. These symptoms are typically worse in the first trimester but may persist throughout pregnancy.

After drinking alcohol or while experiencing a hangover

Alcohol and its subsequent hangovers can also lead to symptoms. Binge drinking, in particular, may lead to vomiting stomach acid.

If you notice that you are experiencing while drinking or after drinking, take into account how much alcohol you have been drinking.

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

When you should see a doctor about vomiting up stomach acid or bile

Vomiting caused by an acute condition like the stomach flu usually resolves on its own within a few days. However, there are some cases where vomiting up stomach acid or bile may warrant a visit to a healthcare professional.

You should see a doctor if:

• Your symptoms are not improving despite your attempts to treat or manage them on your own.
• You notice unexplained weight loss alongside your symptoms.
• You are of childbearing age and have a positive pregnancy test.
• Your symptoms are occurring more frequently or worsening over time.

You should go to the emergency room if:

• You develop acute abdominal pain that does not improve.
• You vomit up blood.
• You cannot keep anything down, including fluids.
• You experience symptoms such as vision loss, heart palpitations, or chest pain alongside vomiting.

Questions to ask your doctor about vomiting stomach acid or bile

• What is causing my vomiting?
• What risk factors should I be aware of regarding my symptoms?
• Are there additional labs, imaging, or workups that may help identify the cause of my symptoms?
• What can I do to manage my vomiting symptoms at home?

Treatment options for vomiting up stomach acid or bile

Depending on the cause of your vomiting, treatment typically includes at-home care combined with medications that can help settle your stomach.

Adequate hydration

When you vomit, you lose fluids and electrolytes, so adequate hydration is important in preventing and treating symptoms.

Because your appetite is also likely lower after vomiting, staying adequately hydrated can help improve your symptoms and prevent complications. Try electrolyte-containing fluids like Gatorade, broths, soups, and water to stay hydrated.

Over-the-counter pain medications

If you are experiencing associated pain, you can try over-the-counter pain medications like Tylenol and Advil.

It is important to note that opioid-containing pain medications can slow the gut down, which may make your symptoms worse.

Anti-nausea or anti-vomiting medications

Lastly, anti-nausea and anti-vomiting medications are available, although most require a prescription from your primary care provider. These include metoclopramide, ondansetron, and droperidol, among others.

Preventing vomiting up stomach acid or bile

In addition to treatment options, you can prevent the development of symptoms associated with vomiting bile or stomach acid.

Anti-nausea or acid-reducing medications

Medication can be helpful not only for treating symptoms but for preventing them, too.

If you notice that you are feeling nauseous or experience signs of acid reflux – such as heartburn – it may help to use over-the-counter medications that can address your symptoms before they lead to vomiting.

Avoid international travel

Certain regions of the world have higher rates of gastroenteritis and other causes that may lead to symptoms due to poor sanitation and other factors.

If you are going to travel internationally, speak with your primary care provider to see if there are any specific diseases you are at higher risk of exposure to. If there are concerns of poor sanitation, ensure good hygiene by frequently washing your hands and drinking bottled water.

Avoid sick contacts

If other people around you are experiencing similar symptoms, try to limit contact with them until their symptoms resolve. Their vomiting may be due to viral gastroenteritis or other causes that can spread to you.

Frequently asked questions: throwing up bile or stomach acid

Because vomiting bile or stomach acid is such a large topic with numerous possible causes, you may still have some questions about your symptoms and possible causes.

Should you go to the ER if you’re throwing up stomach acid?

Not necessarily. If you’ve thrown up a few times, your symptoms may get better over time; however, if you are experiencing other symptoms alongside throwing up stomach acid, like severe pain or high fever, it may be worth consulting a healthcare professional.

What should you do immediately after you throw up stomach acid or bile?

Give yourself and your gut some time to relax. If and when your symptoms improve and you feel a little better, take a small sip of liquid. If your symptoms worsen or you find yourself unable to stop vomiting, speak with your primary care provider.

Read our guide on what to eat or drink after vomiting for more.

Final thoughts: vomiting stomach acid or bile

Vomiting, especially vomiting stomach acid or bile, can be uncomfortable and concerning. If it becomes chronic, it can be disruptive to your quality of life. Fortunately, vomiting typically resolves on its own with plenty of rest and hydration.

However, because there are so many possible causes of symptoms, it is important to understand when it may be time to speak to a healthcare professional. Vomiting up blood, severe pain, high fever, and unexplained symptoms like weight loss may indicate that you need professional treatment. Otherwise, at-home care is likely all you need to manage your symptoms.

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

Flynn, Thomas G, et al. “Viral gastroenteritis.” Lancet (London, England), vol. 403, 2024, pp. 862-876, https://pubmed.ncbi.nlm.nih.gov/17885699/. Accessed 24 Oct. 2024.

Metz, Andrew, and Geoff Hebbard. “Nausea and vomiting in adults--a diagnostic approach.” Australian Family Physician vol. 36, no. 9, 2007, pp. 688-92, https://pubmed.ncbi.nlm.nih.gov/38340741/. Accessed 24 Oct. 2024.