Vomiting Blood After Alcohol Consumption

Blood in your vomit or phlegm from drinking too much alcohol is a serious matter, and help should be sought immediately from your local hospital.

Vomiting blood

Vomiting blood is regurgitating (throwing up) contents of the stomach that contains blood. Vomited blood may appear bright red, dark red, or look like coffee grounds. The vomited material may be mixed with food or it may be blood only.

Considerations

It may be hard to tell the difference between vomiting blood and coughing up blood (from the lung) or a nosebleed. Conditions that cause vomiting blood can also cause blood to appear in the stool.

Causes

• Bleeding ulcer in the stomach, first part of the small intestine, or esophagus
• Blood clotting disorders
• Defects in the blood vessels of the GI tract
• Swelling, irritation, or inflammation of the esophagus lining (esophagitis) or the stomach lining (gastritis)
• Swallowing blood (for example, after a nosebleed)
• Tumors of the mouth, throat, stomach or esophagus

Home Care

Get medical attention right away. Vomiting blood can indicate a serious medical problem.

When to Contact a Medical Professional

Contact your health care provider or go to the emergency room if vomiting of blood occurs. You will need to be examined right away.

What to Expect at Your Office Visit

The provider will examine you and ask questions such as:

• When did the vomiting begin?
• Have you ever vomited blood before?
• How much blood was in the vomit?
• What color was the blood? (Bright or dark red or like coffee grounds?)
• Have you had any recent nosebleeds, surgeries, dental work, vomiting, stomach problems, or severe coughing?
• What other symptoms do you have?
• What medical conditions do you have?
• What medicines do you take?
• Do you drink alcohol, smoke, or use tobacco?

Tests that may be done include:

• Blood work, such as a complete blood count (CBC), blood chemistries, blood clotting tests, and liver function tests
• Esophagogastroduodenoscopy (EGD) (placing a lit tube through the mouth into the esophagus, stomach and duodenum)
• Rectal examination
• Tube through the nose into the stomach and then applying suction to check for blood in the stomach
• X-rays

If you have vomited a lot of blood, you may need emergency treatment. This may include:

• Administration of oxygen
• Blood transfusions
• EGD with application of laser or other treatments to stop the bleeding
• Fluids through a vein
• Medicines to decrease stomach acid
• Possible surgery if bleeding does not stop

References

DeGeorge LM, Nable JV. Gastrointestinal bleeding. In: Walls RM, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 26.

Kovacs TO, Jensen DM. Gastrointestinal hemorrhage. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 126.

Savides TJ, Jensen DM. Gastrointestinal bleeding. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 20.

Version Info

Last reviewed on: 1/30/2023

Reviewed by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Vomiting Blood After Alcohol Consumption

A wide range of conditions and causes can lead to puking blood after drinking.

Coughing after drinking alcohol can be due to anything from asthma to acid reflux. Coughing up blood can be an indication of a large spectrum of issues from not so serious to severe.

Causes for blood in sick can include:

• A tear (called a Mallory-Weiss tear) in the lining of the oesophagus caused by excessive vomiting
• Swollen veins (varices) in the lower part of the oesophagus and stomach. This often happens in people with severe liver damage, including people with long-term alcoholism.
• A bleeding stomach or duodenal ulcer
• Irritation or swelling of the oesophagus called esophagitis
• Throwing up black vomit after excessive drinking is usually dried blood in the intestines that have been there for a while
• A benign (non-cancerous) or cancerous tumour in the stomach or oesophagus
• A severe injury to the abdominal area, as caused by a car accident or blow to the abdomen
• Inflammation of the stomach called gastritis
• Taking too much aspirin or nonsteroidal anti-inflammatory medicines
• A condition called Dieulafoy’s lesion affects an artery in the stomach wall
• Inflammation of the small intestine is called duodenitis
• Pancreatic cancer

Throwing Up Blood After Drinking

Most people who have had a drinking binge will vomit due to alcohol levels being too high for the liver to cope with.

When alcohol breaks down in the liver, a compound called acetaldehyde is made. When acetaldehyde levels become too high, your liver cannot cope, and the body reacts by forcefully expelling the alcohol contents from your stomach.

Throwing up stomach bile after drinking can be concerning as it is a greenish-yellow substance. This fluid is created by the liver and stored in your gallbladder.

Bile isn’t always cause for concern. You may see it if you have a less serious condition that causes vomiting while your stomach is empty.

Throwing up blood is a bit different from the common occurrence of being sick after drinking too much.

Blood in your vomit or phlegm from drinking too much alcohol is a serious matter, and help should be sought immediately from your local hospital.

This is a terrifying moment for any heavy drinker, but burying your head in the sand is only going to make things worse, so seek rehabilitation and try to get help immediately.

Remember, there are various reasons why you throw up blood after drinking.

A Rupture In the Gastrointestinal Tract

In people with alcohol-associated gastritis, in contrast to those problems with some other causes, the symptoms may be perceived only after a night of binge drinking or, alternately, might display as a more chronic difficulty for individuals who engage in frequent, heavy drinking.

The upper gastrointestinal tract consists of your mouth, pharynx, oesophagus, small intestine and stomach.

When a rupture occurs in this area, bleeding occurs (hematemesis or coffee-ground emesis). This coffee-like, brown vomit may also indicate that you have a stomach ulcer, which means immediate help is needed.

Hematemesis is defined as vomiting blood, which indicates bleeding from the oesophagus, stomach, or duodenum.

Hematemesis includes vomiting of bright red blood, suggestive of recent or ongoing bleeding, and dark material, which suggests bleeding that had stopped some time ago. (1,2)

How Does Cirrhosis Cause Blood in Vomit?

Cirrhosis causes irreversible scarring of the liver.

The main conditions causes are sustained through excessive alcohol consumption, hepatitis B and C, and fatty liver disease; there are also many other possible causes for the liver to become diseased.

There are many warning signs that the liver is failing, and vomiting blood is one of them.

This particular symptom is called ‘Esophageal Varices’ and occurs in the late stages of liver disease.

The vomiting of blood can be from ulcers in the stomach or leaking varicose veins. If someone has reached this stage without seeking medical help, they should do so immediately.

Ulcers

If you are throwing up bloody sick, an ulcer could be the cause.

Helicobacter pylori bacteria usually cause ulcers in the stomach.

Consuming copious amounts of alcohol can also bring on ulcers as the alcohol aggravates the stomach lining, making it red, raw and inflamed, which causes bleeding.

Alcohol can irritate an ulcer that already exists, especially excessive alcohol use can also disrupt the healing process, allowing the ulcers to expand and worsen because of this. (3)

Gastritis

Gastritis is the inflammation of the stomach lining and, like ulcers, can cause gastrointestinal bleeding. Gastritis has many causes, such as:

• Excessive alcohol consumption
• Abuse of aspirin or ibuprofen
• Post-surgical gastritis
• Traumatic injury
• Burns
• Infections
• Stress

Conditions such as gastritis and a rupture in the gastrointestinal tract may also become life-threatening. These are much more serious than side effects like Delirium Tremens.

Oesophageal varices

The liver has the ability to regenerate itself after being damaged more than a few times. Still, if alcohol consumption has gone to a level of alcoholism, the liver’s regenerative repairs become less than perfect, resulting in scar tissues forming a hard, scarred liver.

As a result, the blood that usually passes down easily from the oesophagus to the liver becomes difficult due to the scarred liver.

When this happens, the body’s veins enlarge with the trapped blood and flow back upstream into the oesophagus again. Due to this, the blood vessels rupture and cause a person to throw up blood. As a result, the body loses a significant amount of blood. Therefore, medical treatment in an emergency room is required immediately.

Diagnosing Reasons For Vomiting Blood

There are many reasons why someone may see blood in their vomit after drinking, but whatever you think the reason is, you could be wrong; therefore, it is always best to seek medical attention if this occurs.

If someone has been drinking red wine, for example, they may throw up red-coloured vomit. This is explainable. However, red-coloured vomit must be checked out if you haven’t been drinking red-coloured.

Upper endoscopy is the mainstay of initial investigations to decide the bleed source and the specific therapy. Diagnosis will usually involve a detailed history and a physical examination.

No matter how serious or debilitating your addiction, professional help is out there – and if you have reached the point where you can ask for that help, it could be only a phone call away.

Vomiting and Nutritional Problems

Vomiting blood after drinking can be a vicious cycle and deplete your body’s reserves. An alcohol detox supplement could be helpful to your recovery.