What Causes Black Vomit (Coffee Grounds Vomitus)?

The color of your vomit can be a sign of a serious health condition.

Black or brown vomit can be a sign of internal bleeding.

This type of vomit is also often called “coffee ground vomitus” as the partially digested blood looks like coffee grounds and is caused by bleeding in the gastrointestinal (GI) tract.

While this may be a sign of a serious health condition, it is important to note that black vomit can also be caused by something less concerning.

If you are worried about the color of your vomit, you should consult with a healthcare professional.

In this article, we will discuss the various causes and symptoms of black vomit, diagnosis, treatment, and when you should see a healthcare professional.

Symptoms

Dark vomit often comes from bleeding in the stomach. It can be from several causes, including the following:

• A gastric ulcer or gastritis
• Inflammation of the stomach lining from things like nonsteroidal anti-inflammatory drugs (NSAIDs like Advil), infections, and smoking

Anyone who vomits blood or a substance that resembles coffee grounds should seek immediate medical attention. If you are unable to get to the emergency room, you should call for an ambulance.

Other symptoms that may indicate an emergency situation include:

• Chest pain
• Dizziness
• Shortness of breath
• Pale skin
• Severe pain in the abdomen
• Feeling of lightheadedness
• Bright red blood in the vomit
• Large clots in the vomit
• Fainting

The other symptoms that may accompany coffee ground vomitus will vary depending on the underlying condition.

Causes 

There are many potential causes of black vomit.

Some causes are more serious than others and may require urgent medical attention.

Potential causes of black vomit include:

Upper gastrointestinal (GI) bleeding

Gastrointestinal bleeding (GI) is internal bleeding from the esophagus, stomach, or small intestine.

It can be mild or severe and life-threatening. If the bleeding is mild, upper abdominal pain or black stools may be your first sign of bleeding.

Severe bleeding can irritate the GI tract, leading to vomit that looks like coffee grounds.

A common cause of upper GI inflammation (gastritis, esophagitis) or an ulcer is a bacterial infection known as H. pylori.

Symptoms of GI bleeding can include:

• Upper abdominal pain that gets worse when you eat
• Fatigue/lightheadedness due to blood loss
• Black or tarry stools from digested blood
• Blood in the stool

Acute variceal hemorrhage

Acute variceal hemorrhage is caused by varices, or enlarged blood vessels.

They occur when scarring in the liver causes pressure in the blood vessels, leading to the backflow of blood into the blood vessels in the esophagus.

This causes vessels in the esophagus to dilate, weaken, and eventually leak or burst.

If the blood leaks, it will go into your stomach.

If it is completely digested, you will have black or tarry stool. If it is partially digested and vomited it may look like coffee grounds. Vomited undigested blood will look bright red.

Symptoms of acute variceal hemorrhage include:

• Fatigue
• Lightheadedness
• Pale color
• Black/tarry stool
• Jaundice (yellow skin and/or eyes)
• Distended abdomen
• Abdominal pain

Peptic ulcer

Peptic ulcers can form anywhere on the lining of the stomach or your small intestines.

They are sores or breaks in the stomach lining caused by inflammation.

This is usually caused by:

• Infection with the bacteria, H pylori
• Medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) or aspirin
• Alcohol overuse

Some symptoms of peptic ulcer include:

• Burning upper abdominal pain that gets worse after eating
• Loss of appetite and/or nausea
• Bloating or belching

Stomach cancer

Stomach cancer is a tumor in your stomach.

The cancer is usually in the main part of the stomach or where the esophagus (the long tube that carries food) meets the stomach (gastroesophageal junction).

Common symptoms include:

• Abdominal pain that gets worse after eating
• Abdominal bloating
• Unintentional weight loss
• Fatigue
• Feeling full after eating very little

Other possible causes

A number of other conditions may also cause black or brown vomit, though these are either uncommon, or black or brown vomit is not usually the defining symptom:

• The malformation of blood vessels (angiodysplasia and other abnormalities) increases the risk of bleeding.
• Tears known as Mallory-Weiss tears occur after repeated, forceful vomiting, but usually resolve on their own.
• Swallowing a foreign body that injures a part of your esophagus or stomach.
• A complication from a procedure, such as an endoscopy.
• Bulimia

Diagnosis

To diagnose the cause of coffee ground vomitus or any contributing factors, a healthcare professional will ask for your medical history including your medication use as well as ask about other symptoms.

Most people will need a physical exam and blood tests to start the evaluation.

In addition to this, a person may receive one or more of the following tests:

• Gastric occult blood testing is a test your healthcare professional can use to look for blood in the vomitus.
• An upper GI endoscopy is a procedure in which a gastroenterologist inserts a small flexible scope with a camera down your esophagus to view internal organs.
• A barium study is a special x-ray that uses a contrast dye (called barium) which you’ll swallow to help your doctor identify problems in your GI tract.
• Liver function studies are blood tests that can help your doctor identify any diseases or damage to your liver.
• Fecal occult blood testing is a test that can detect blood in your stool.
• During a flexible sigmoidoscopy or a colonoscopy, your doctor inserts a small scope with a camera through your anus and into the colon and rectum.

Treatment

The treatment for coffee ground vomitus will vary greatly depending on the underlying cause.

A doctor will need to determine what is causing the blood to appear in the vomit before making any recommendations on treatment.

If an ulcer or gastritis is causing a person’s coffee ground vomitus, a doctor may treat it with the following:

• Antibiotics to treat helicobacter pylori infection that causes ulcers
• Acid-reducing medications to reduce the stomach acid and allow the stomach to heal
• Antacids to provide pain relief and neutralize existing stomach acids
• Medications to protect the stomach lining

For people with upper GI cancer, a doctor will tailor treatment to the type and stage of cancer.

Treatment for upper GI cancer may include:

• Surgical removal of the cancer
• Chemotherapy
• Radiation therapy
• Immunotherapy

A doctor may treat someone with beta-blockers if coffee ground vomitus is found to be from esophageal varices. This medication will reduce blood pressure in the bleeding vein.

The doctor may also recommend rubber band ligation, which will involve using elastic bands to tie off bleeding veins to stop the bleeding.

When to Seek Medical Attention

Anyone who experiences coffee ground vomitus should seek emergency medical attention as soon as possible. 

A doctor will need to diagnose the underlying cause of coffee ground vomitus before recommending treatment.

The severity of the underlying condition will determine how long it will take for a person to recover and see a reduction in symptoms.

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