Salem Press

Salem Health: Cancer
Hematemesis

Category: Diseases, symptoms, and conditions

Also Known As: Vomiting of blood

Related Conditions
Esophagus, stomach (gastric), and duodenum ulcers, esophagitis, gastritis, esophagus and stomach cancers, esophageal and stomach varices, melena, Mallory-Weiss tears, Dieulafoy's lesion, blood clotting problems, cirrhosis, portal hypertension

Definition
Hematemesis is vomiting of blood or material that resembles coffee grounds from the upper gastrointestinal (UGI) tract, which includes the mouth, part of the throat, the esophagus, the stomach and the first part of the small intestine called the duodenum up to the ligament of Treitz, a tough fibrous-muscle band tissue supporting the duodenum.

Risk Factors
Risk factors for hematemesis include prolonged vomiting, bleeding ulcers, Helicobacter pylori infection, nosebleeds, and use of nonsteroidal anti-inflammatory drugs, alcohol, and tobacco.

Etiology and the Disease Process
Hematemesis and melena (black, tarry stools) are common symptoms of upper gastrointestinal bleeding (UGIB). The most common causes of UGIB include esophagitis, gastritis, peptic ulcer disease, esophagogastric varices, arteriovenous malformations (abnormal blood vessels in the digestive tract), Mallory-Weiss tears (lacerations on the lining of the junction of the esophagus and stomach), tumors (cancers), and nonspecific abnormalities of the upper gastrointestinal lining.

Incidence
Approximately 100 cases of upper gastrointestinal bleeding occur per 100,000 hospitalizations annually; this bleeding causes hematemesis.

Symptoms
Vomiting of blood is the result of upper gastrointestinal bleeding. Although not all cases can cause a major medical problem, it is necessary to seek medical help immediately. If large quantities of blood are lost, the patient could develop low blood pressure, increased heart rate, and shock.

Screening and Diagnosis
A flexible tube extending from the nose or mouth to the stomach and into the duodenum will be inserted to remove blood and prevent blood going into the lungs. Blood tests will include blood clotting factors, liver function tests, and a complete blood count, which evaluates how much blood was lost. Upper endoscopy will be performed to visualize the upper gastrointestinal tract and to treat the bleeding. If endoscopy fails to identify the site of bleeding, other methods such as angiography (radiographic visualization of blood vessels) and radioactive scan of tagged red blood cells can be employed.

Treatment and Therapy
Endoscopic treatments to stop bleeding include injection methods with absolute alcohol, salt solution, or epinephrine, or mechanical methods such as applying heat directly and placing hemoclips (metal clips for grasping blood vessels or surrounding tissues). A combination of injection followed by mechanical methods is another treatment modality. If H. pylori infection is present, the bacteria will be eradicated with antimicrobials, proton pump inhibitors, and acid suppressors. Aspirin and nonsteroidal anti-inflammatory drugs will be stopped. If large volumes of blood are lost, emergency measures may include intravenous fluids, blood transfusions, and medications such as proton pump inhibitors and acid suppressors. Consultations will include a gastroenterologist and a surgeon, who may operate if bleeding does not stop.

Prognosis, Prevention, and Outcomes
Repeated hematemesis due to upper gastrointestinal tract bleeding increases mortality rate. Associated factors that increase the mortality rate include age, poor nutrition, and having other medical problems and blood clotting disorders. Related medical conditions such as ulcers should be appropriately treated and risk factors addressed for prevention.

Miriam E. Schwartz, M.D., M.A., Ph.D., and Colm A. Ó'Moráin, M.A., M.D., M.Sc., D.Sc.

See Also
esophageal cancer; esophagitis; gastrointestinal cancers; lymphomas; stomach cancers; symptoms and cancer.

Miriam E. Schwartz, M.D., M.A., Ph.D.,
and Colm A. Ó'Moráin, M.A., M.D., M.Sc., D.Sc.