Vomiting of blood (hematemesis)

Hematemesis is the medical term for vomiting blood (vomiting blood), which is usually due to bleeding in the upper gastrointestinal tract (gastrointestinal tract). Any bleeding in the gastrointestinal tract is potentially life-threatening with a mortality rate of around 10 percent and should therefore be examined by a doctor immediately.

What is vomiting of blood?

Hematemesis is the vomiting of blood as a result of bleeding in the upper gastrointestinal tract (gastrointestinal tract), especially the esophagus (gullet), stomach and duodenum (duodenum).

The vomited blood is usually bright red in color. However, if this has come into contact with stomach acid, so-called hematin forms, giving the blood a color similar to coffee grounds.

In the long term, vomiting blood due to blood loss can lead to anemia (paleness, shortness of breath, weakness), circulatory impairment and, in the case of massive blood loss, to shock-like conditions (fear, palpitations, pale and cold sweaty skin, impaired consciousness), which is why an immediate medical evaluation is necessary if a hematemesis is present .

causes

In addition to tarry stools, vomiting blood is a key symptom of bleeding in the upper gastrointestinal tract, which can be traced back to various causes. The upper gastrointestinal tract includes the esophagus (gullet), stomach and duodenum (duodenum).

Vomiting of blood is most commonly caused by bleeding ulcers (ulcus ventriculi) or duodenum (ulcus duodeni) and damage to the mucous membrane or ruptured varices (varicose veins) in the esophagus or stomach (gastric fundus varices).

In addition, Mallory-Weiss syndrome, which is accompanied by abrupt and jerky vomiting with subsequent bleeding in the gastrointestinal tract as a result of longitudinal mucosal lesions, and erosive gastritis (preliminary stage of a gastric ulcer) can result in hematemesis.

In rare cases, hematemesis can also be caused by stomach cancer, gastric polyps, or vascular diseases. A heavy nosebleed that has entered the esophagus and then vomited is very rarely the cause of a hematemesis.

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Diseases with this symptom

• Esophageal cancer
• alcoholism
• Esophageal varices
• Mallory-Weiss Syndrome

• Cirrhosis of the liver
• Liver disease
• gastritis
• Stomach cancer

• Gastric polyps
• Esophageal variceal bleeding
• Gastric ulcer
• Duodenal ulcer

Diagnosis & course

A hematemesis is diagnosed on the basis of the blood present in the vomit and known previous illnesses that can cause blood vomiting.

The color of the blood can already indicate the underlying cause. For example, light red blood usually indicates bleeding in the esophagus, while a black or coffee grounds-like color indicates bleeding damage to the stomach or duodenum.

A mirror image of the esophagus and gastrointestinal tract should be performed to precisely localize the source of the bleeding.

In some cases, blood analyzes, x-rays and sonographies (ultrasound examinations) are also used to confirm the diagnosis.

A hematemesis can usually be treated well, depending on the underlying disease. In order to avoid impairment of the circulatory system through massive blood loss, the cause of a hematemesis should be treated quickly.

Complications

Vomiting blood is just a symptom, not a disease in itself. From this it can be deduced that there is a disease that causes vomiting of blood. Most of the complications that can arise are due to the underlying medical condition.

Complications arising directly from the act of vomiting blood can be, for example, aspiration of vomit and fear. During aspiration, the vomit enters the windpipe, so it is inhaled. This initially creates a strong urge to cough, the aim of which is to push the aspirated vomit out of the airways. If this is not successful, there is a risk of suffocation in the worst case. If the vomit gets into the lungs, it can lead to infection and inflammation there.

Anxiety and even panic attacks are another complication of vomiting blood. In the worst case, the patient is paralyzed by fear and unable to act rationally. This in turn favors aspiration of the vomit.

The underlying disease that triggers the symptom of vomiting blood can cause various complications, some of which are life-threatening. An example here is a heavy loss of blood with a wide range of negative consequences. In general, the consequences and complications of the diseases that may be present cannot be explained in more detail, since a number of diseases and injuries can lead to vomiting of blood.

When should you go to the doctor?

In hematemesis, the vomiting of blood, the blood comes from one of the areas of the upper gastrointestinal tract: esophagus, stomach or duodenum. Vomit blood that has passed through the stomach takes on a blackish, coffee grounds-like appearance due to the stomach acid, which is why vomiting blood is popularly referred to as breaking coffee grounds.

On the other hand, vomited blood that has not come into contact with gastric acid appears a fresh red and mostly comes from a damaged varicose vein of the esophagus. In rare cases, vomited blood can also come from the nasopharynx, for example in the case of severe nosebleeds. A doctor should always be consulted in the event of a hematemesis. After all, 10% of bleeding from the gastrointestinal tract is fatal!

The main causes of blood vomiting are ulcers of the stomach or duodenum, gastritis as well as injuries to the mucous membrane and torn varicose veins in the esophagus or stomach. Haematemesis occurs in Mallory-Weiss syndrome, which is associated with mucosal lesions and often preceded by excessive alcohol consumption for several years. In addition to these particularly frequent triggers of blood vomiting, vascular diseases, gastric polyps and gastric cancer should also be considered when determining the cause.

In the case of vomiting blood, the family doctor is a competent contact person who, after an initial inventory, usually involves other specialists in the treatment: above all the gastroenterologist, internist or oncologist.

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Treatment & Therapy

In the case of a hematemesis, the therapeutic measures are primarily aimed at stopping the bleeding immediately and eliminating the underlying disease. In many cases, fluids and electrolytes are infused intravenously to compensate for the loss of water and minerals due to the vomiting of blood to stabilize the circulation.

In the event of massive blood loss, an intravenous infusion of blood reserves or red blood cell concentrates (concentrated red blood cells) may be necessary. To clarify the cause of the hematemesis, a timely emergency endoscopy (mirroring) is usually carried out, during which the gastrointestinal bleeding can not only be localized but, if necessary, the underlying disease can also be eliminated.

If, for example, there is a torn esophageal varice (varicose vein in the esophagus), this can be endoscopically sclerosed (obliterated) and the bleeding stopped. If there is a bleeding gastric ulcer, surgery may be indicated to remove the ulcer. If the gastric ulcer is caused by an infection with Helicobacter pylori, then antibiotic therapy (including amoxicillin or clarithromycin) is used.

In addition, regardless of a possible bacterial infestation, proton pump inhibitors such as pantoprazole or omeprazole are used to reduce gastric acid production in order to accelerate the regeneration (healing) of the gastric mucosa and to prevent blood from breaking again.

Outlook & forecast

Acute vomiting of blood is an emergency. It has to be acted quickly. Life-saving hemostasis must be carried out immediately.

Often another illness is the cause of the vomiting blood. Once it is clear what it is, the sputum can be healed. If this clinical picture develops after great physical exertion, most likely walls of blood vessels have torn. It is then important to take sufficient care of the body. The injured blood vessels heal by themselves.

If the cause of the vomiting is an eating disorder, this is a high burden on the organism. Regular vomiting can damage blood vessels. The sufferer should definitely begin therapy for the eating disorder. If it is successful, the vomiting of blood will be relieved, in the best case complete healing.

As a side effect of a strong or chronic cough, vomiting blood is also possible. Treating the common cold will improve the symptoms. After the cold has completely healed, the bloody sputum will also be gone.

In the worst case scenario, the vomiting blood will result from a tumor or a benign ulcer. The symptoms will only subside when the tumor or benign ulcer is surgically removed.

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prevention

Hematemesis can be prevented by taking measures that minimize the risk of mucosal defects. An unhealthy diet, excessive alcohol and nicotine consumption, and long-term use of certain pain relievers (acetylsalicylic acid, diclofenac) are among the risk factors for diseases that can lead to hematemesis.

You can do that yourself

Vomiting blood is almost always a sign of serious illness. In the event of a first attack, the necessary self-help measures must be initiated immediately. The emergency doctor must be informed immediately. The person affected should straighten their upper body slightly if possible. It is best for the person affected to get into a sitting position and lean the upper body slightly forward. Under no circumstances should the patient lie on their back as there is a risk of blood entering the lungs.

Vomiting blood often triggers shock for those affected. The patient should then be put into shock position and legs raised. If the patient loses consciousness before the ambulance arrives, he should be brought into the stable side position.

A disease of the gastrointestinal tract is usually responsible for the regular vomiting of blood. Often gastritis is the trigger. In this case, the patient can do a lot to ensure that the underlying disease heals and that the symptom vomiting blood occurs less frequently. A change in lifestyle is particularly helpful. Anyone who smokes and drinks alcohol regularly should refrain from doing so. Heavy, high-fat food is also better replaced by light, vegetarian food. In addition, too much black or very strong coffee can irritate the stomach. If the gastritis is stress-related, learning a relaxation technique helps.