What Causes Black or Brown Vomit?
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The color of your vomit can be a sign of a potentially life-threatening problem. Black or brown vomit may mean that you are bleeding internally. It is often called coffee ground vomitus (the partially digested blood looks like coffee grounds) and is caused by bleeding in your gastrointestinal (GI) tract.
Dark vomit often comes from bleeding in the stomach. It can be from several causes:
- A gastric ulcer or gastritis
- Inflammation of the stomach lining from things like nonsteroidal antiinflammatory drugs (NSAIDs like Advil), infections, and smoking
Gastric ulcers and gastritis can also cause upper abdominal pain that gets worse when you eat and black or tarry-looking stools.
Less common causes include esophageal varices (abnormally enlarged blood vessels), liver failure, and tumors that break through tissue in the GI tract.
It’s important to treat dark vomit as a medical emergency.
If your vomit is brown or black, immediately go to the ER. Especially if you keep vomiting or have dizziness, heart palpitations, chest pain, or shortness of breath.
1. Upper gastrointestinal (GI) bleeding
If you vomit brown or black, first think about what you were eating before you vomited. Often, your vomit is a similar color to food you eat. However, if you did not eat recently or have any risk factors for an upper gastrointestinal (GI) bleed, vomiting this color may be a sign of bleeding. —Dr. Chandra Manuelpillai
- Upper abdominal pain that gets worse when you eat
- Fatigue/lightheadedness due to blood loss
- Black or tarry stools from digested blood
Gastrointestinal bleeding is internal bleeding from the esophagus, stomach, or the 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. Warning: Bright red vomit is a sign of severe bleeding and is very serious.
If your doctor thinks you have an infection, you will be tested and, if needed, put on antibiotics. If treated correctly, the GI tract can heal, preventing upper GI bleeding.
If you develop black or tarry stools, see your doctor as soon as possible to determine the cause of the bleeding. Your body can heal itself if treatment is started early.
If you are vomiting dark (coffee ground) vomit or bright, red blood, call 911 immediately. (Do not go to urgent care for either condition; you need to go to a hospital.)
2. Acute variceal hemorrhage
- Pale color
- Black/tarry stool
- Jaundice (yellow skin and/or eyes)
- Distended abdomen
- Abdominal pain, usually in the upper right of the abdomen
Acute variceal hemorrhage is caused by varices—enlarged blood vessels. They occur when scarring in the liver causes pressure in the blood vessels of the liver, leading to the backflow of blood into the blood vessels in the esophagus. This causes vessels in the esophagus to dilate and 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, it will be vomited as coffee ground vomit. If the vessels burst, it often leads to bright red vomit.
Treatment depends on how bad the bleeding is. Sometimes undetected varices are discovered during an endoscopy (a test to examine the upper GI tract through a camera on a thin tube). Sometimes gastroenterologists (GI specialists) band the varices to prevent them from bleeding or prescribe medication to decrease the pressure within the vessels of the esophagus.
Since the main cause is from scarring of the liver, a liver transplant or TIPS (transjugular intrahepatic portal shutting) procedure may be needed to relieve the pressure.
Active, rapid bleeding is a life-threatening medical emergency. At the hospital, you may undergo procedures to stop the bleeding including passing a large, narrow balloon into the esophagus and inflating it to apply pressure directly to the esophagus. Or an emergency endoscopy to locate and stop the bleeding.
3. Peptic ulcer
Inflammation or irritation and ulcers are serious conditions. Both can lead to internal bleeding, which can be life-threatening if the bleeding is really bad. —Dr. Manuelpillai
- Burning upper abdominal pain that gets worse after eating
- Loss of appetite and/or nausea
- Bloating or belching
Peptic ulcers, also called stomach 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
Just as with a cut or other injury, your body needs time to heal. But it’s difficult for your stomach because every time you eat, you release acid to digest the food. This can re-injure the stomach lining.
Your doctor may prescribe medications that decrease acid production, protecting the stomach lining, and/or treat H pylori infection, if present. You should also avoid alcohol, smoking, and foods and medications that can cause irritation and inflammation.
Should I go to the ER for black or brown vomit?
If you throw up black or brown vomit, and have any of these symptoms, go to the ER:
- You start throwing up black or brown vomit or large amounts of blood.
- You vomit more than 1 to 2 times or worsens and you cannot keep food or liquid down.
- You have severe abdominal pain.
- You develop dizziness, chest pain, shortness of breath, or heart palpitations.
If you don’t have these more serious symptoms, call your doctor to see if you should go directly to an ER or come in for an office visit.
4. Stomach cancer
- Abdominal pain that gets worse after eating
- Abdominal bloating
- Unintentional weight loss
- Feeling full after eating very little
Stomach cancer is a tumor in your stomach. The cancer is usually in the main part of the stomach (stomach body) or where the esophagus (the long tube that carries food) meets the stomach (gastroesophageal junction). It can be benign/non-cancerous or malignant/cancer.
Treatment depends on the location of the cancer. But surgery is usually needed to remove the tumor.
Other possible causes
A number of 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) that increases the risk of bleeding.
- Tears known as Mallory-Weiss tears that 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, an eating disorder.
Black or brown vomit treatments
A common misconception is that milk will treat gastritis and/or peptic ulcers. People believe it will “coat” the esophagus, stomach, or ulcers. In fact, milk is acidic and may worsen it. —Dr. Manuelpillai
To stop GI bleeding, your doctor might suggest the following procedures:
- Embolization, which involves injecting particles directly into blood vessels to stop bleeding.
- Ligation—the use of special bands to treat bleeding vessels, especially in the esophagus.
- Clipping to close the defective part of the blood vessel.
- Surgery for uncontrollable bleeding.
Depending on the cause, your doctor might prescribe you:
- Antibiotics (amoxicillin, clarithromycin, or levofloxacin).
- Acid reducers known as proton pump inhibitors to help reduce stomach acid by blocking the cells that produce it.
- Acid blockers known as histamine blockers to reduce the amount of acid your stomach makes.
- Antacids to neutralize stomach acid and provide quick relief.
If these treatments aren’t working and you are stable, your doctor may do an upper endoscopy or colonoscopy (or both) to examine the GI tract. This will help identify inflammation, ulcers, varices, vessel malformations, and tumors. Your doctor may also take a biopsy of tissue to look for cancer or infection.
Dr. Manuelpillai is a board-certified Emergency Medicine physician. She received her undergraduate degree in Health Science Studies from Quinnipiac University (2002). She then went on to graduated from Rosalind Franklin University of Medicine and Sciences/The Chicago Medical School (2007) where she served on the Executive Student Council, as well as was the alternate delegate to the AMA/ISMS-MSS Governing Council and the student representative to the Illinois State Medical Society (ISMS) Education and Health Workforce committee. She completed an internship year with UCLA-Harbor Medical Center's Department of Internal Medicine followed by an emergency medicine residency program at Boston Medical Center (2011) while also serving as the resident representative to the Massachusetts Medical Society (MMS) committee on Student Health & Sports Medicine. She then started working at Saints Medical Center (later Lowell General Hospital/Saints Campus and Main Campus) in Lowell Massachusetts where she served as the Continuous Quality Improvement Director for the emergency medicine group, as well as was the representative for the emergency department on the Sepsis, Stroke and PCI Quality Assurance and Compliance Committees. She joined Buoy Health in 2019. She currently works in multiple emergency departments both in the community and academics, as well as previously worked in multiple urgent care centers. She believes this mix of experiences has given her a unique perspective on the care of acute illnesses.