Black Vomit (Hematemesis): Causes, Urgency & What to Do

Black, coffee-ground vomit = hematemesis = upper GI bleeding. This is a medical emergency requiring immediate evaluation.

Why It's Black

Gastric acid denatures hemoglobin → hematin (dark brown/black). "Coffee grounds" = partially digested blood. Bright red = brisk, active bleed.

Major Causes

• Peptic ulcer disease (H. pylori, NSAIDs) — #1 cause.
• Esophageal varices (cirrhosis/portal hypertension) — life-threatening, high volume.
• Mallory-Weiss tear: Forceful vomiting → mucosal laceration at GE junction.
• Gastritis/erosive gastropathy: NSAIDs, alcohol, stress.
• Malignancy: Gastric/esophageal cancer.
• Dieulafoy lesion: Arterial bleed from submucosal vessel.
• Swallowed blood: Epistaxis, dental/oral surgery.

Medication Artifacts (Non-Bloody Black)

• Iron supplements
• Bismuth subsalicylate (Pepto-Bismol)
• Activated charcoal
• Dark foods (licorice, blueberries)

Immediate Action

1. Call 911 / Go to ER — do not drive yourself.
2. Do not eat/drink (NPO for endoscopy).
3. Bring medication list.

Hospital Management

• Resuscitation (IV access, blood products, octreotide/terlipressin if varices suspected).
• PPI IV (pantoprazole 80 mg bolus + 8 mg/hr infusion).
• Urgent upper endoscopy (within 24 hrs; <12 hrs if high-risk).
• Admission, monitoring, transfusion threshold Hb <7–8.

Black vomit = upper GI bleed until proven otherwise. Time is tissue.