Vomiting a substance that resembles coffee grounds, medically known as coffee ground emesis, is a sign of internal bleeding within the upper gastrointestinal (GI) tract. The upper GI tract includes the esophagus, the stomach, and the duodenum (the first part of the small intestine). While the appearance may suggest the bleeding has slowed or stopped, this symptom always indicates a potentially life-threatening gastrointestinal hemorrhage requiring urgent medical attention.
Understanding the Appearance
The dark, granular look is caused by blood that has been partially digested by stomach acids, not fresh, bright red blood. The stomach contains hydrochloric acid and the protein-digesting enzyme, pepsin. When blood enters the stomach, the acid oxidizes the iron in the hemoglobin of red blood cells.
This process denatures the hemoglobin, transforming the vibrant red color of fresh blood into a dark brown or black substance. The resulting granular material is essentially clotted blood altered by the acidic environment, giving it the characteristic coffee-ground texture. This material indicates the blood has been in the stomach for a period of time, often at least 30 minutes, before being expelled.
Conditions Causing Upper GI Bleeding
The source of the bleeding is always located in the upper GI tract, and several serious conditions can cause coffee ground emesis. The most frequent cause is peptic ulcer disease, involving open sores on the lining of the stomach or the duodenum. These ulcers are often caused by Helicobacter pylori infection or the long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. The ulcer erodes into a blood vessel, leading to hemorrhage.
Another common source is severe gastritis, which is inflammation and irritation of the stomach lining. This inflammation can lead to small bleeds or erosions sufficient to produce the characteristic dark vomit. Similarly, esophagitis, or inflammation of the esophageal lining, typically due to chronic acid reflux, can also cause bleeding.
In individuals with advanced liver disease, esophageal varices present a high risk. Liver damage causes blood flow to back up, leading to abnormally enlarged veins in the lower esophagus and stomach. These fragile vessels can rupture, causing a massive hemorrhage that may present as coffee ground emesis or bright red blood. A Mallory-Weiss tear is an esophageal injury, often caused by violent retching or vomiting.
Less common causes include cancers of the stomach or esophagus, as well as vascular malformations like Dieulafoy lesions, where a small artery protrudes through the GI tract lining. In all cases, the concern is that the bleeding continues, potentially leading to significant blood loss and hemodynamic instability.
Immediate Emergency Response
Coffee ground emesis is a medical emergency demanding immediate professional attention, as internal bleeding can quickly become life-threatening. Do not attempt to self-medicate or wait for symptoms to resolve. The safest immediate action is to call emergency services (such as 911) or go directly to the nearest emergency department.
While waiting for help, monitor for signs of severe blood loss or shock.
Signs of Severe Blood Loss
- Rapid heart rate
- Low blood pressure
- Dizziness or lightheadedness, especially when standing
- Confusion
- Extreme paleness of the skin
- Weakness or faintness
If the person is conscious, position them sitting upright or leaning forward to minimize the risk of aspiration. If unconscious but breathing, place them in the recovery position (on their side) to protect the airway. These measures focus on stabilizing the individual until medical professionals arrive.
Medical Diagnosis and Treatment
Upon arrival at the hospital, the medical team’s first priority is patient stabilization and rapid assessment of blood loss severity. This includes establishing two large-bore intravenous (IV) lines to administer fluids and, if necessary, blood transfusions. Patients showing signs of shock or severe ongoing bleeding are often admitted to an intensive care unit for close observation.
The definitive diagnostic and therapeutic procedure is an upper endoscopy, or esophagogastroduodenoscopy (EGD). During this procedure, a flexible tube with a camera is passed down the throat into the esophagus, stomach, and duodenum, allowing the physician to visualize the hemorrhage source directly. The procedure is typically performed within 24 hours for prompt identification and treatment.
Once the bleeding site is found, the endoscope delivers targeted treatment. This may involve endoscopic intervention, such as injecting the site with epinephrine, applying heat (thermocoagulation), or deploying small metal clips to stop the bleed. Patients are also started on high-dose intravenous proton pump inhibitors (PPIs) to suppress stomach acid production, creating a favorable environment for healing. If endoscopic methods fail, surgical intervention or specialized radiological procedures may be required.