Upper GI Bleeding (Hematemesis)

What is hematemesis?

Hematemesis is the vomiting of blood. The bleeding is usually from the upper gastrointestinal (GI) tract. This means the bleeding may be from the esophagus (the tube that connects the mouth and stomach), the stomach, or the upper small intestine (duodenum).

If you are having bloody vomit, you need to get medical care right away.

How does it occur?

Common causes of upper GI bleeding are:

• an ulcer in the stomach or small intestine
• irritation of the stomach (gastritis) or esophagus (esophagitis)
• medicines called NSAIDs, such as aspirin, ibuprofen, and naproxen, that can irritate the stomach and esophagus
• liver disease from chronic alcohol use.

Sometimes the esophagus bleeds because it is torn. These tears may happen after forceful coughing or vomiting.

It is unusual but possible for cancers of the stomach and esophagus to cause large amounts of bloody vomit

What are the symptoms?

Vomiting blood can be a very frightening experience. In mild cases, you may notice small amounts of bright, red blood in your vomit. Or you may see dark brown or black material that looks like coffee grounds. This is blood that has been digested by stomach acids. If the bleeding is severe, you may keep vomiting large amounts of bright red blood.

You may have other symptoms, depending on the cause of the vomiting of blood. These symptoms may be:

• heartburn
• stomach pain
• dark, black, tarry bowel movements.

Black, tarry stools may mean that you have had bleeding from your stomach or intestines for some time. Blood that passes through the intestines is digested and looks black.

How is it diagnosed?

Your healthcare provider will ask about your personal and family medical history and your symptoms. You will have a physical exam. You may also have:

• blood tests, including tests for anemia, to see how much blood you have lost
• a test to look for blood in your bowel movements
• an X-ray of your esophagus or stomach
• an upper endoscopy.

For an endoscopy your provider will give you medicine to sedate you. Then he or she will insert a thin, flexible tube with a tiny camera through your mouth, into your esophagus and stomach, and into the upper small intestine to look for causes of bleeding. The endoscope can be used to look for varicose veins of the esophagus, irritation of the lining of the esophagus or stomach organs, or an ulcer.

How is it treated?

If the bleeding is severe, you will be treated in the emergency room and hospital, maybe even in the intensive care unit. The first goal of treatment is to stop the bleeding. You need to have enough fluids and blood to maintain a normal blood pressure to keep you alert and keep your organs healthy (such as your brain, heart, and kidneys). You will have an IV line for intravenous fluids and medicines. You may also be given oxygen with a small short tube in your nose. You will probably have a nasogastric tube, which is a slim, flexible plastic tube that passes through your nose down into your stomach. Your healthcare provider can give you medicines through the nasogastric tube to help stop the bleeding. Your provider can also use the tube to get samples of stomach fluids so he or she can tell if the bleeding has stopped.

If you have severe bleeding and it can't be stopped, a special tube with a balloon on the end of it may be inserted into your esophagus. Once in place, the balloon can be blown up so that it presses on the area of bleeding to stop it. You may need emergency surgery to stop the bleeding.

Depending on how fast your bleeding stops and why you are bleeding in the first place, you will be in the hospital at least 1 day or more. You will have treatment for the underlying cause of the bleeding as well.

Whether the bleeding is mild or severe, you will have blood tests to help measure how much blood you have lost and to see if your blood has problems clotting. The tests may also help determine why you are having the bleeding. You may have one or more endoscopies to look for the cause and to see if the bleeding is likely to restart.

If the bleeding is mild (occasional or small amount), the treatment will depend on the cause of the bleeding. For example:

• You may need to stop taking medicines that irritate your digestive system.
• Forceful vomiting can be treated with medicine to stop nausea and vomiting.
• Gastritis and ulcers can be treated with medicine.
• You may need to stop smoking or stop drinking alcohol because nicotine and alcohol irritate the stomach.
• Problems with the esophagus may be treated with surgery or medicine.

Your provider will recommend a soft diet while you are healing.

How can I take care of myself?

• Follow your healthcare provider's instructions carefully. Make sure you take all prescribed medicines and follow any special diets your provider recommends.
• If the bleeding was caused by alcohol abuse, you need to follow your healthcare provider's recommendations for getting help to stop drinking.
• Keep all follow-up appointments with your healthcare provider.
• Make sure you know what to do if the bleeding starts again.

How can I help prevent GI bleeding?

Prompt treatment of the frequent causes of vomiting blood may keep it from ever happening. Tell your healthcare provider if you have stomach pain, heartburn, or acid indigestion.

• Get prompt medical care if you have:
  • bright, red blood in your vomit or bowel movements
  • dark brown or black material in your vomit that looks like coffee grounds
  • dark, black, tarry bowel movements

If you drink too much alcohol, you are at high risk of developing scarring of the liver (cirrhosis) and problems with your esophagus and stomach that may cause sudden, severe bleeding. You will need to get help with your drinking problem.