Black Vomit: 9 Causes & What to Do

Black vomit can happen when there is minor or heavier bleeding in the gastrointestinal tract. It may be caused by conditions such as gastritis, Crohn’s disease, yellow fever, esophageal varices, or the use of certain medications.

Depending on the cause, other symptoms may also be present. These can include stomach pain, a burning sensation, weakness, fever, dark stools, and unexplained weight loss.

If black vomit occurs, with or without other symptoms, it is recommended to see a primary care provider or gastroenterologist. A complete evaluation can help identify the cause and guide the most appropriate treatment.

Main causes

The main causes of black vomit are:

1. Gastritis

Gastritis is inflammation that can damage the lining of the stomach. This can lead to stomach ulcers that may bleed and cause black vomit.

Gastritis symptoms can also include pain in the stomach, indigestion, frequent burping, and a burning sensation.

What to do: treatment is done with medications such as omeprazole, aluminum hydroxide, and pantoprazole, which should be prescribed by a healthcare provider.

It is also important to follow an appropriate diet. This includes prioritizing cooked vegetables and fruits, and reducing the intake of foods and drinks such as coffee, black tea, soda, alcoholic beverages, sauces, and fatty or spicy foods.

2. Crohn’s disease

Crohn’s disease is an inflammatory bowel disease that usually causes symptoms such as frequent diarrhea, abdominal pain, blood in the stool, and fever.

However, in rarer cases, Crohn’s disease can also cause black vomit due to the presence of blood.

What to do: treatment mainly includes medications such as corticosteroids, immunosuppressants, and antibiotics, as well as a balanced diet planned by a registered dietitian or other nutrition specialist.

3. Yellow fever

According to the World Health Organization (WHO), severe yellow fever can cause vomiting and bleeding from the mouth, nose, eyes, or stomach.

Yellow fever is an infectious disease caused by a virus transmitted by mosquitoes such as Aedes aegypti and Haemagogus sabethes. It can cause symptoms such as severe headache, high fever, widespread muscle pain, intense abdominal pain, and, in severe cases, black vomit due to the presence of blood.

What to do: treatment includes resting; drinking plenty of fluids, such as water, coconut water, natural juices, or teas; and taking medications prescribed by a healthcare provider, such as acetaminophen, omeprazole, and metoclopramide.

4. Peptic ulcer

A peptic ulcer, also known as a gastric ulcer, is a sore that can cause bleeding in the stomach, leading to black vomit. Other symptoms that may also occur with a peptic ulcer include stomach pain that gets worse when eating or drinking, abdominal bloating, and blood in the stool.

What to do: treatment should be guided by a gastroenterologist and aims to relieve symptoms and prevent the ulcer from getting worse.

The doctor may recommend changes in eating habits and the use of antibiotics, such as amoxicillin or metronidazole, proton pump inhibitors, such as omeprazole and lansoprazole, pain relievers, and antacids.

5. Esophageal varices

Esophageal varices are enlarged veins in the esophagus that can bleed. This can cause symptoms such as black vomit, dark or black stools, dizziness, and weakness, and may be life-threatening in more severe cases.

What to do: treatment may be done with medications such as propranolol, vasopressin, or octreotide; placement of an elastic band around the varices; or a surgery called a hepatic shunt, which is mainly done in more severe cases.

6. Esophagitis

Esophagitis is inflammation of the esophagus that can damage the wall of the esophagus. This can cause bleeding and lead to symptoms such as black vomit, heartburn, a bitter taste in the mouth, difficulty swallowing, and sore throat.

What to do: treatment should be recommended by a gastroenterologist. Medications that reduce acid production, such as omeprazole or esomeprazole, are usually recommended.

It is also recommended to follow a balanced diet and make lifestyle changes, such as avoiding lying down after meals.

7. Gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is when stomach contents flow back into the esophagus. This can cause ongoing inflammation of the esophageal wall and may lead to black vomit due to the presence of blood.

GERD can also cause symptoms such as burning, heartburn, burping, a frequent dry cough, and a feeling of a lump in the throat.

What to do: treatment can include simple measures, such as following an appropriate diet, or using medications such as antacids, metoclopramide, or omeprazole. These medications can help speed up stomach emptying, reduce the amount of acid in the stomach, or neutralize stomach acid.

8. Certain medications

The use of medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, diclofenac, naproxen, or aspirin, can cause stomach bleeding and lead to black vomit.

According to the FDA, NSAIDs can increase the risk of serious gastrointestinal side effects, including bleeding, ulceration, and perforation of the stomach or intestines. 

What to do: it is best to speak with the doctor who prescribed these medications to see whether the dose can be reduced or if they can be switched to an alternative.

9. Stomach or esophageal cancer

Black vomit can occur due to stomach or esophageal cancer. These conditions can cause bleeding in the gastrointestinal tract, especially in more advanced stages of the disease.

In addition to black vomit, other symptoms that may also be present include loss of appetite, frequent abdominal pain, unexplained weight loss, excessive tiredness, difficulty or pain when swallowing, and dark, foul-smelling stools.

What to do: treatment for stomach and esophageal cancer may include surgery, radiation therapy, chemotherapy, or immunotherapy. These treatments should be recommended by a doctor according to the type and stage of cancer and the person’s overall health.