Vomiting blood after drinking alcohol, known as hematemesis, is never normal and indicates internal bleeding within the upper gastrointestinal (GI) tract. The upper GI tract includes the esophagus, stomach, and the first part of the small intestine. This symptom requires immediate medical attention and should be treated as an emergency until the cause is identified.
Immediate Assessment and Triage
Any instance of vomiting blood must be promptly assessed by a medical professional. The appearance and volume of the blood offer initial clues about the source and severity of the bleeding. Bright red blood suggests a fresh, active bleed in the esophagus or upper stomach, often indicating rapid or significant blood loss. If the vomited material looks dark, brown, and grainy, described as “coffee grounds,” it suggests the blood has been partially digested by stomach acid, signaling a serious internal hemorrhage.
Seek emergency services immediately if the volume of blood is large, or if the bleeding is accompanied by severe abdominal pain, dizziness, fainting, or a rapid heart rate. These symptoms can signal hypovolemic shock, a life-threatening result of severe blood loss.
Acute Causes of Esophageal and Gastric Bleeding
One common acute cause of bleeding after heavy drinking and vomiting is a Mallory-Weiss tear. This involves a laceration in the mucous membrane where the esophagus meets the stomach, caused by the sudden, intense pressure generated during forceful retching. The bleeding typically presents as bright red blood. Although the bleeding often stops on its own, it can occasionally lead to significant hemorrhage that requires medical intervention.
Another frequent cause of acute upper GI bleeding is acute erosive gastritis, which is sudden inflammation and superficial damage to the stomach lining. Alcohol is a direct irritant to the gastric mucosa, and high concentrations can cause chemical erosion. This irritation makes the stomach lining more vulnerable to damage from its own acid. The resulting erosions can cause superficial bleeding, which may manifest as blood or “coffee grounds” material in the vomit. This condition is usually short-lived if the irritant is removed, but it still requires medical diagnosis to rule out more severe causes.
Underlying Conditions and Chronic Risks
Vomiting blood may also indicate a pre-existing or chronic condition that heavy alcohol use has aggravated. Peptic ulcers, which are open sores in the lining of the stomach or the first part of the small intestine (duodenum), are a common cause of upper GI bleeding. Alcohol irritates these sores, preventing healing and significantly increasing the risk of a bleeding episode. Heavy consumption of four or more drinks per week has been shown to increase the risk of a bleeding ulcer.
A more severe, chronic risk involves the development of esophageal varices, which are enlarged, fragile veins in the lower part of the esophagus. These varices form due to portal hypertension, a condition where blood flow to the liver is blocked, often by scar tissue from advanced liver disease, such as alcoholic cirrhosis. The increased pressure forces blood into smaller, weaker veins, causing them to balloon and become prone to rupture. Bleeding from ruptured varices is extremely serious, as it can result in massive, rapid blood loss and carries a high mortality rate.
Medical Diagnosis and Recovery
Once a person who has vomited blood arrives for medical care, the immediate focus is on stabilizing their condition, which may involve intravenous fluids or blood transfusions to compensate for blood loss. The definitive diagnostic tool used to locate the source of the bleeding is an upper endoscopy, also known as an esophagogastroduodenoscopy (EGD). During the EGD procedure, a specialist inserts a flexible tube equipped with a camera to examine the esophagus, stomach, and duodenum. This allows for direct visualization and immediate treatment of the bleeding source, whether it is a tear, gastritis, or a bleeding ulcer or varix.
Treatment during the endoscopy may involve injecting the site with epinephrine to cause vasoconstriction, applying thermal energy to cauterize the blood vessel, or using endoscopic clips to mechanically close the tear or ulcer. Recovery and long-term prevention depend entirely on the underlying cause. For alcohol-related issues, abstaining from alcohol is a necessary step to allow the GI tract to heal and prevent recurrence. Follow-up care is essential to ensure the underlying cause, such as a peptic ulcer or liver disease, is managed to avoid future bleeding episodes.