Quick answer. Vomiting blood (haematemesis) is most often caused by a bleeding peptic ulcer, gastritis, a Mallory-Weiss tear or oesophageal varices. It is a medical emergency — the biggest red flag is vomiting a large amount of fresh red blood or feeling faint, in which case you must call 995 immediately.
Vomiting blood, known medically as haematemesis, means bringing up blood from your upper digestive tract — the food pipe (oesophagus), stomach or the first part of the small intestine. The blood may be bright red, or it can look dark like coffee grounds when it has been partly digested by stomach acid. Either way, it should always be taken seriously.
In Singapore, common causes include peptic ulcers, gastritis and tears from forceful vomiting, while more serious causes such as bleeding oesophageal varices are linked to liver disease. Because vomiting blood can be a sign of significant internal bleeding, this guide focuses first on emergency warning signs, then explains the main causes and which specialist can investigate and treat the underlying problem.
At a glance
| Possible cause | Typical features | How urgent |
|---|---|---|
| Peptic ulcer | Upper tummy pain, indigestion, dark or red vomit | Emergency — call 995 / A&E |
| Oesophageal varices | Liver disease history, sudden large bleed | Emergency — call 995 / A&E |
| Mallory-Weiss tear | Bleeding after intense vomiting or retching | Urgent medical assessment |
| Gastritis | Burning upper tummy pain, nausea, small bleeds | See a doctor promptly |
| Swallowed blood | From nosebleed or dental bleeding | Assess source; seek advice |
Red flags: when to seek urgent care
Vomiting blood is a medical emergency. Call 995 or go to A&E immediately if you vomit blood, especially with any of the following:
- A large amount of fresh, bright red blood, or repeated vomiting of blood.
- Vomit that looks like coffee grounds (dark, gritty), which means blood that has been in the stomach.
- Feeling faint, dizzy, very weak, pale, sweaty or about to collapse.
- Black, tarry, foul-smelling stools (melaena), which suggest digested blood from the gut.
- Severe tummy pain, a fast heartbeat or shortness of breath.
Do not eat or drink anything while you wait for help, as you may need an urgent procedure. Even a small amount of vomited blood needs same-day medical assessment.
Peptic ulcers
A peptic ulcer is an open sore in the lining of the stomach or the first part of the small intestine. Ulcers are commonly caused by Helicobacter pylori infection or by regular use of anti-inflammatory painkillers (NSAIDs).
When an ulcer erodes into a blood vessel, it can bleed, causing vomiting of red blood or coffee-ground material and black tarry stools. Other clues include burning or gnawing upper tummy pain and indigestion. A bleeding ulcer is an emergency that needs urgent treatment, often with an endoscopy to stop the bleeding.
Oesophageal varices
Oesophageal varices are swollen, fragile veins in the lower food pipe. They usually develop in people with advanced liver disease (cirrhosis), where increased pressure in the liver’s blood vessels backs up into the veins of the oesophagus.
If these veins burst, they can cause sudden, heavy bleeding and vomiting of large amounts of bright red blood. This is one of the most dangerous causes of haematemesis and requires emergency treatment. Anyone with known liver disease who vomits blood should call 995 without delay.
Mallory-Weiss tears and gastritis
A Mallory-Weiss tear is a tear in the lining where the oesophagus meets the stomach, typically caused by violent or repeated vomiting and retching — for example during a stomach bug or after heavy alcohol intake. It can produce streaks or larger amounts of blood in vomit.
Gastritis is inflammation of the stomach lining, which can be irritated by infection, alcohol, NSAIDs or stress. It causes burning upper tummy pain, nausea and sometimes small amounts of bleeding. Both conditions still warrant prompt medical assessment to confirm the diagnosis and rule out more serious bleeding.
Swallowed blood and coffee-ground vomit
Not all blood in vomit comes from the stomach. Swallowed blood from a heavy nosebleed or bleeding in the mouth or after dental work can later be vomited and mistaken for haematemesis.
The colour of the blood gives important clues:
- Bright red blood suggests fresh, active bleeding from the oesophagus or stomach.
- Coffee-ground vomit (dark brown, gritty) means blood that has been altered by stomach acid — still a sign of bleeding that needs urgent assessment.
If you are unsure of the source, treat it as serious and seek medical care.
Which specialist should you see?
After emergency stabilisation, the specialist who investigates and treats vomiting blood is a gastroenterologist (digestive system specialist), who can perform an endoscopy to find and treat the source of bleeding. You can compare and find a doctor here: best gastroenterologists in Singapore.
Remember that vomiting blood is an emergency: if it is happening now, especially with large amounts of blood, coffee-ground vomit, black stools or feeling faint, call 995 or go straight to A&E rather than waiting for a clinic appointment.
What happens at the hospital
If you vomit blood, the priority is stabilising you. At A&E the team will check your pulse, blood pressure and oxygen, place a drip and take blood tests, and may give fluids or a blood transfusion if you have lost a lot of blood. Once you are stable, a gastroenterologist usually performs an endoscopy, in which a thin flexible camera is passed through the mouth to find the source of bleeding and, where possible, treat it during the same procedure.
How to reduce your risk
- Use anti-inflammatory painkillers (NSAIDs) only as advised, and tell your doctor if you need them regularly, as they can irritate the stomach lining.
- If you have been diagnosed with Helicobacter pylori, complete the full course of treatment.
- Keep alcohol within sensible limits, as heavy drinking can cause gastritis, tears and liver disease.
- If you have known liver disease or varices, attend your follow-up appointments and take prescribed medicines to lower bleeding risk.
Common questions
What does coffee-ground vomit mean?
Dark, gritty vomit that looks like coffee grounds is blood that has been altered by stomach acid. It still indicates bleeding in the upper digestive tract and needs urgent assessment, even if you feel otherwise well.
Could the blood be from my nose or mouth instead?
Sometimes. Swallowed blood from a heavy nosebleed or after dental work can be vomited later and look like bleeding from the stomach. If you are unsure of the source, treat it as serious and seek medical care.
Related guides
- Best Gastroenterology Clinics in Singapore — our editorial shortlist
- gastroenterology clinics directory
- Coughing up blood
- Wheezing
- Double vision
Sources
- NHS — Vomiting blood (haematemesis)
- HealthHub Singapore — Peptic Ulcer
- SingHealth — Gastrointestinal Bleeding
- Mayo Clinic — Vomiting blood
Part of our Digestive, liver & gut guides · Browse all health topics