What is it about ?
Vomiting blood is the result of bleeding in the first part digestive tract (mouth, esophagus, stomach or duodenum). Vomiting blood should not be confused with coughing up blood (hemoptysis), in which you cough up blood from the lungs.
The most common causes of vomiting blood are:
- esophageal varices (esophageal varices) i.e. severely dilated veins under the lining of the esophagus caused by chronic liver disease such as cirrhosis ;
- a Mallory-Weiss tear, i.e. a tear caused in the lining of the stomach by intense vomiting, most often at the junction between the esophagus and the stomach;
- an ulcer in the stomach or duodenum (peptic ulcer), i.e. an ulcer in the layer of mucous membrane that protects the stomach or duodenum;
- erosion of the stomach, i.e. a superficial degradation of the lining of the stomach that is mainly encountered in the elderly who take anti-inflammatory drugs.
What is its frequency?
Among all the patients who must be operated on urgently, there is an acute gastrointestinal bleeding (therefore in the stomach or intestines) in 5 out of 100 patients. And 8 times out of 10, this bleeding occurs. are located in the first part of the digestive tract.
How to recognize it?
You are vomiting blood. The color of this blood can range from bright red with sudden heavy bleeding, to tarry black with slower bleeding when the blood stays in the stomach longer.
Sudden heavy bleeding, but of very short duration, always gives rise to signs of shock: pallor, cold sweating, rapid heartbeat, drop in blood pressure and dizziness on standing. Normal blood pressure in a person with high blood pressure can also indicate the onset of shock.
The slower and constant bleeding sometimes goes unnoticed for a long time. The body adapts to it in a way. In this case, the first tell-tale sign of bleeding is often a black, sticky stool (melena).
If you vomit blood due to esophageal varices, the blood is bright red. This type of bleeding often stops quickly, but starts again easily. It can be fatal.
In the case of a Mallory-Weiss tear, the person vomits violently the contents of their stomach at first, then usually a large amount of bright colored blood. Most often, this bleeding stops spontaneously.
a peptic ulcer causes severe stomach pain and vomiting of brightly colored blood. The bleeding is often slower and longer. Old blood also mixes with the stool, which turns black and looks like tar.
A stomach erosion has more or less the same symptoms as a stomach ulcer.
How is the diagnosis made?
The doctor will ask you if you are using (or have used) anti-inflammatory drugs, if you have ever had stomach ulcers, if you consume alcohol and in what amounts, if you have (had) any liver cirrhosis, if the vomiting of blood has happened suddenly and you feel dizzy when you stand up.
The doctor looks for signs of shock during the physical examination and may do a rectal exam, as the presence of blood in the stools or dark, tarry stools indicates that bleeding is in progress. It also examines the possible existence of signs suggestive of chronic liver disease, such as a liver that is too large (enlarged) or hard to touch, the appearance of breasts in men (gynecomastia) and jaundice.
If you vomit a lot of blood, you will be referred urgently for further tests and urgent treatment. To identify the exact cause of vomiting blood, an examination of the upper part of the digestive tract is done using a flexible tube fitted with a camera (gastroscopy).
What can your doctor do?
The doctor will take care above all to avoid the shock. Blood and serum transfusion may be necessary. Then, he will find the cause of the bleeding as quickly as possible and stop the bleeding.
Esophageal varices
If you have esophageal varices, you will first and foremost be given medicines that lower the pressure in the varicose veins in the esophagus. Antibiotic therapy is required for cirrhosis of the liver. If you have varicose veins that keep bleeding, a kind of balloon is inserted and inflated into your esophagus to compress the varicose veins and stop the bleeding. The doctor can then inject a product that hardens the tissue (sclerosing product) in the varicose veins.
Mallory-Weiss tear
The diagnosis of a Mallory-Weiss tear is made on the basis of a gastroscopy. A small tear that bleeds a little from strong vomiting often does not require treatment, but sometimes surgery is necessary for larger tears.
Peptic ulcer
A bleeding peptic ulcer can be treated with a gastroscopy, by injecting adrenaline into the blood vessel, cauterizing the blood vessel, using a heated probe, or by applying a special glue. After 24 hours, the doctor checks to see if the bleeding has stopped. If these treatments do not work, surgery is required.
During the gastroscopy, the doctor also takes small pieces of tissue (biopsies) from the ulcer to look for bacteria. Helicobacter pylori under a microscope. If this bacteria is present in the stomach, antibiotic therapy is started. The bacteria Helicobacter pylori can cause peptic ulcers. Antacids have no effect on bleeding per se, but they do prevent an ulcer from bleeding.
Stomach erosion
The treatment of an erosion of the bleeding stomach follows the same principles as that of a peptic ulcer. To prevent recurrence of bleeding, we check whether anti-inflammatory drugs or aspirin are really necessary. The doctor may consider treatment with antacids.
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