Coffee ground vomiting

Last updated
Coffee ground vomiting
Specialty Gastroenterology
Symptoms Vomiting dark blood
Causes Gastritis
Gastrointestinal bleeding
Stomach cancer
Yellow fever

Coffee ground vomitus refers to a particular appearance of vomit. Within organic heme molecules of red blood cells is the element iron, which oxidizes following exposure to gastric acid. This reaction causes the vomitus to look like ground coffee.

Contents

Causes

Esophagitis, esophageal varices, gastritis, cirrhosis or gastric ulcers for example, may bleed and produce coffee-ground vomitus. When unaccompanied by melena, hematemesis or a fall in hemoglobin with corresponding urea rises and creates an unstable reaction, and other causes of coffee ground vomitus need to be elucidated; for example, gastric stasis, bowel obstruction or ileus, that can cause oxidised food material to be vomited. Vomiting iron supplements can also mimic coffee grounds to the untrained eye. [1]

Diseases such as Ebola, yellow fever, viral hepatitis, haemophilia B, fatty liver disease and cancers of stomach, pancreas, esophagus and, rarely, retrograde jejunogastric intussusception might also be the reason behind coffee-ground vomitus. [2] [3]

When attributed to peptic inflammation, use of nonsteroidal anti-inflammatory drugs (NSAIDs) is commonly implicated. These drugs can interfere with the stomach's natural defenses against the strongly acidic environment, causing damage to the mucosa that can result in bleeding. Therefore, it is recommended that these class of drugs be taken with food or on a full stomach. Other causes of inflammation may be due to severe gastroesophageal reflux disease, Helicobacter pylori gastritis, portal hypertensive gastropathy or malignancy.

When bright red blood is vomited, it is termed hematemesis. Hematemesis, in contrast to coffee ground vomitus, suggests that upper gastrointestinal bleeding is more acute or more severe, for example due to a Mallory–Weiss tear, gastric ulcer or Dieulafoy's lesion, or esophageal varices. This condition may be a medical emergency and urgent care may be required. [4] [5] [1]

Oxidized blood from an upper gastrointestinal bleed can also be excreted in stool. It produces blackened, "tarry" stools known as melena. [6] [1]

Evaluation

Upper endoscopy can be used to locate bleeding in the upper gastrointestinal system. In this method a camera is inserted through the mouth to visualize the esophagus, stomach, and duodenum.

Numerous studies have suggested that urgent endoscopy is not required for coffee ground emesis alone. [7] [8] Other factors, such as hemodynamic stability, hemoglobin concentration, and various elements of the patient's history may guide clinicians to obtain or defer urgent endoscopy. Additionally, nasogastric aspirates can be used to predict the likelihood that endoscopy will reveal high-risk bleeding. [9]

While endoscopic visualization may be sufficient for diagnosis, a biopsy may also be taken during endoscopy, aiding in the diagnosis of H. pylori infections, and differentiating tumors.

CT angiography may also be used to locate the source of upper-GI bleeding. [10]

Management

Treatment of coffee ground emesis depends on underlying etiology. Patient history and initial labs, especially hemoglobin, can help stratify patients by need for immediate intervention.

Bleeding ulcers believed to be caused by H. pylori infections are typically treated with a combination of medications. Medications used in the treatment of such ulcers fall into two categories. First, medications are used to decrease pain associated with ulcers by limiting acid exposure to sensitive ulcers. This can be accomplished by medications that reduce stomach acid production, such as proton pump inhibitors (PPI) or H2-blockers, or through conventional antacids. Sucralfate is also effective in this role, as it coats the ulcer, thus protecting it from caustic stomach acid. Second, antibiotic therapy is used to eliminate the underlying bacterial infection. Clarithromycin and amoxicillin are commonly used in tandem, but antibiotic regiments may vary based on organism susceptibility, side effects, and patient allergies. Gastric ulcers caused by NSAID use can be treated with NSAID cessation, or a proton pump inhibitor if cessation is not possible. Non-healing ulcers should be examined for other causes, such as cancer or Zollinger-Elison syndrome. [11]

Esophageal bleeding is predominantly caused by gastrointestinal reflux disease (GERD). PPI medications are preferred to H2-blocking medication due to increased rates of patient improvement, though both medications are commonly used. Severe cases of GERD may be refractory to these medications and require fundoplication, a surgery in which the gastroesophageal junction is surgically reinforced. While lifestyle modifications, diet modification, and antacid use may reduce GERD symptoms such as heartburn, these methods are not sufficient to heal esophageal ulcers. [12]

Variceal bleeding may be treated through a variety of medications and interventions, depending on underlying causes and severity. Severe cases are unlikely to present as coffee ground emesis, and are more likely to present as bright red vomitus. [13]

Esophageal lacerations (Mallory-Weiss tears) are mostly self-limiting, though the majority require blood transfusions to compensate for blood loss. Endoscopic interventions, including epinephrine injections, clipping, and cauterization may be utilized if needed. [14]

Related Research Articles

<span class="mw-page-title-main">Gastroenterology</span> Branch of medicine focused on the digestive system and its disorders

Gastroenterology is the branch of medicine focused on the digestive system and its disorders. The digestive system consists of the gastrointestinal tract, sometimes referred to as the GI tract, which includes the esophagus, stomach, small intestine and large intestine as well as the accessory organs of digestion which include the pancreas, gallbladder, and liver.

<span class="mw-page-title-main">Peptic ulcer disease</span> Ulcer of an area of the gastrointestinal tract

Peptic ulcer disease is a break in the inner lining of the stomach, the first part of the small intestine, or sometimes the lower esophagus. An ulcer in the stomach is called a gastric ulcer, while one in the first part of the intestines is a duodenal ulcer. The most common symptoms of a duodenal ulcer are waking at night with upper abdominal pain, and upper abdominal pain that improves with eating. With a gastric ulcer, the pain may worsen with eating. The pain is often described as a burning or dull ache. Other symptoms include belching, vomiting, weight loss, or poor appetite. About a third of older people with peptic ulcers have no symptoms. Complications may include bleeding, perforation, and blockage of the stomach. Bleeding occurs in as many as 15% of cases.

Heartburn, also known as pyrosis, cardialgia or acid indigestion, is a burning sensation in the central chest or upper central abdomen. Heartburn is usually due to regurgitation of gastric acid into the esophagus. It is the major symptom of gastroesophageal reflux disease (GERD).

<span class="mw-page-title-main">Gastroesophageal reflux disease</span> Flow of stomach contents into the esophagus

Gastroesophageal reflux disease (GERD) or gastro-oesophageal reflux disease (GORD) is a chronic upper gastrointestinal disease in which stomach content persistently and regularly flows up into the esophagus, resulting in symptoms and/or complications. Symptoms include dental corrosion, dysphagia, heartburn, odynophagia, regurgitation, non-cardiac chest pain, extraesophageal symptoms such as chronic cough, hoarseness, reflux-induced laryngitis, or asthma. In the long term, and when not treated, complications such as esophagitis, esophageal stricture, and Barrett's esophagus may arise.

<span class="mw-page-title-main">Esophagitis</span> Inflammation of the esophagus

Esophagitis, also spelled oesophagitis, is a disease characterized by inflammation of the esophagus. The esophagus is a tube composed of a mucosal lining, and longitudinal and circular smooth muscle fibers. It connects the pharynx to the stomach; swallowed food and liquids normally pass through it.

<span class="mw-page-title-main">Upper gastrointestinal bleeding</span> Medical condition

Upper gastrointestinal bleeding (UGIB) is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum. Blood may be observed in vomit or in altered form as black stool. Depending on the amount of the blood loss, symptoms may include shock.

Hematemesis is the vomiting of blood. It can be confused with hemoptysis or epistaxis (nosebleed), which are more common. The source is generally the upper gastrointestinal tract, typically above the suspensory muscle of duodenum. It may be caused by ulcers, tumors of the stomach or esophagus, varices, prolonged and vigorous retching, gastroenteritis, ingested blood, or certain drugs.

<span class="mw-page-title-main">Melena</span> Medical condition with dark feces

Melena is a form of blood in stool which refers to the dark black, tarry feces that are commonly associated with upper gastrointestinal bleeding. The black color and characteristic strong odor are caused by hemoglobin in the blood being altered by digestive enzymes and intestinal bacteria.

<span class="mw-page-title-main">Esophagogastroduodenoscopy</span> Diagnostic endoscopic procedure

Esophagogastroduodenoscopy (EGD) or oesophagogastroduodenoscopy (OGD), also called by various other names, is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract down to the duodenum. It is considered a minimally invasive procedure since it does not require an incision into one of the major body cavities and does not require any significant recovery after the procedure. However, a sore throat is common.

<span class="mw-page-title-main">Dieulafoy's lesion</span> Medical condition

Dieulafoy's lesion is a medical condition characterized by a large tortuous artery most commonly in the stomach wall (submucosal) that erodes and bleeds. It can present in any part of the gastrointestinal tract. It can cause gastric hemorrhage but is relatively uncommon. It is thought to cause less than 5% of all gastrointestinal bleeds in adults. It was named after French surgeon Paul Georges Dieulafoy, who described this condition in his paper "Exulceratio simplex: Leçons 1-3" in 1898. It is also called "caliber-persistent artery" or "aneurysm" of gastric vessels. However, unlike most other aneurysms, these are thought to be developmental malformations rather than degenerative changes.

<span class="mw-page-title-main">Gastrointestinal bleeding</span> Medical condition

Gastrointestinal bleeding, also called gastrointestinal hemorrhage (GIB), is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum. When there is significant blood loss over a short time, symptoms may include vomiting red blood, vomiting black blood, bloody stool, or black stool. Small amounts of bleeding over a long time may cause iron-deficiency anemia resulting in feeling tired or heart-related chest pain. Other symptoms may include abdominal pain, shortness of breath, pale skin, or passing out. Sometimes in those with small amounts of bleeding no symptoms may be present.

<span class="mw-page-title-main">Gastritis</span> Stomach disease

Gastritis is the inflammation of the lining of the stomach. It may occur as a short episode or may be of a long duration. There may be no symptoms but, when symptoms are present, the most common is upper abdominal pain. Other possible symptoms include nausea and vomiting, bloating, loss of appetite and heartburn. Complications may include stomach bleeding, stomach ulcers, and stomach tumors. When due to autoimmune problems, low red blood cells due to not enough vitamin B12 may occur, a condition known as pernicious anemia.

<span class="mw-page-title-main">Mallory–Weiss syndrome</span> Bleeding from a laceration in the mucosa at the junction of the stomach and esophagus

Mallory–Weiss syndrome or gastro-esophageal laceration syndrome refers to bleeding from a laceration in the mucosa at the junction of the stomach and esophagus. This is usually caused by severe vomiting because of alcoholism or bulimia, but can be caused by any condition which causes violent vomiting and retching such as food poisoning. The syndrome presents with hematemesis. The laceration is sometimes referred to as a Mallory–Weiss tear.

<span class="mw-page-title-main">Gastric varices</span> Dilated submucosal veins in the stomach lining

Gastric varices are dilated submucosal veins in the lining of the stomach, which can be a life-threatening cause of bleeding in the upper gastrointestinal tract. They are most commonly found in patients with portal hypertension, or elevated pressure in the portal vein system, which may be a complication of cirrhosis. Gastric varices may also be found in patients with thrombosis of the splenic vein, into which the short gastric veins that drain the fundus of the stomach flow. The latter may be a complication of acute pancreatitis, pancreatic cancer, or other abdominal tumours, as well as hepatitis C. Gastric varices and associated bleeding are a potential complication of schistosomiasis resulting from portal hypertension.

Indigestion, also known as dyspepsia or upset stomach, is a condition of impaired digestion. Symptoms may include upper abdominal fullness, heartburn, nausea, belching, or upper abdominal pain. People may also experience feeling full earlier than expected when eating. Indigestion is relatively common, affecting 20% of people at some point during their life, and is frequently caused by gastroesophageal reflux disease (GERD) or gastritis.

<span class="mw-page-title-main">Gastric outlet obstruction</span> Medical condition

Gastric outlet obstruction (GOO) is a medical condition where there is an obstruction at the level of the pylorus, which is the outlet of the stomach. Individuals with gastric outlet obstruction will often have recurrent vomiting of food that has accumulated in the stomach, but which cannot pass into the small intestine due to the obstruction. The stomach often dilates to accommodate food intake and secretions. Causes of gastric outlet obstruction include both benign causes, as well as malignant causes, such as gastric cancer.

<span class="mw-page-title-main">Vomiting</span> Involuntary, forceful expulsion of stomach contents, typically via the mouth

Vomiting is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose.

A stress ulcer is a single or multiple mucosal defect usually caused by physiological stress which can become complicated by upper gastrointestinal bleeding. These ulcers can be caused by shock, sepsis, trauma or other conditions and are found in patients with chronic illnesses. These ulcers are a significant issue in patients in critical and intensive care.

<span class="mw-page-title-main">Portal hypertensive gastropathy</span> Changes in the mucosa of the stomach in patients with portal hypertension

Portal hypertensive gastropathy refers to changes in the mucosa of the stomach in patients with portal hypertension; by far the most common cause of this is cirrhosis of the liver. These changes in the mucosa include friability of the mucosa and the presence of ectatic blood vessels at the surface. Patients with portal hypertensive gastropathy may experience bleeding from the stomach, which may uncommonly manifest itself in vomiting blood or melena; however, portal hypertension may cause several other more common sources of upper gastrointestinal bleeding, such as esophageal varices and gastric varices. On endoscopic evaluation of the stomach, this condition shows a characteristic mosaic or "snake-skin" appearance to the mucosa of the stomach.

<span class="mw-page-title-main">Stomach disease</span> Medical condition

Stomach diseases include gastritis, gastroparesis, Crohn's disease and various cancers.

References

  1. 1 2 3 "Overview of Gastrointestinal Bleeding - Gastrointestinal Disorders". MSD Manual Professional Edition. Retrieved 2022-03-27.
  2. ↑ "Coffee ground vomitus: Causes, symptoms, and treatment". www.medicalnewstoday.com. 2018-06-12. Retrieved 2022-03-27.
  3. ↑ Gangdhar, Kiran (2012). "A Rare Cause of Coffee-Ground Vomiting". SA Journal of Radiology: 2.
  4. ↑ "Vomiting blood". Mayo Clinic.
  5. ↑ "Vomiting blood (haematemesis)". nhs.uk. 2017-10-18. Retrieved 2022-03-27.
  6. ↑ Zhao, R; Loh, K; Mian, M; Chong, C; Lim, K (May 2017). "Malaena but not coffee ground vomit or bright haematemesis predicts adverse outcomes in acute upper gastro intestinal bleeding". Internal Medicine Journal. 47: 16. doi: 10.1111/imj.16_13461 . ISSN   1444-0903. S2CID   79800375.
  7. ↑ Schneider, James R.; Thomson, John M.; Fraser, Andrew; Vijayan, Balasubramaniam; Bassett, Paul; Leeds, John S. (July 2020). "Is coffee ground vomiting important? Findings from a large bleeding unit database and outcomes at 30 days". European Journal of Gastroenterology & Hepatology. 32 (7): 797–803. doi:10.1097/MEG.0000000000001701. ISSN   0954-691X. PMID   32175981. S2CID   212730089.
  8. ↑ Khani, Aria; Maksunova, Yulia; Patel, Mehul; Besherdas, Kalpesh (2018-06-01). "PTH-035 Coffee ground vomit:does it justify an urgent endoscopy?". Gut. 67 (Suppl 1): A29–A30. doi: 10.1136/gutjnl-2018-BSGAbstracts.56 . ISSN   0017-5749.
  9. ↑ Aljebreen, Abdulrahman M; Fallone, Carlo A; Barkun, Alan N; for the RUGBE investigators (February 2004). "Nasogastric aspirate predicts high-risk endoscopic lesions in patients with acute upper-GI bleeding". Gastrointestinal Endoscopy. 59 (2): 172–178. doi:10.1016/S0016-5107(03)02543-4. PMID   14745388.
  10. ↑ "UpToDate". www.uptodate.com. Retrieved 2023-02-10.
  11. ↑ Cashin, Paul A.; Chung, S.C. Sydney (2019-12-18), Smith, Julian A.; Kaye, Andrew H.; Christophi, Christopher; Brown, Wendy A. (eds.), "Peptic ulcer disease", Textbook of Surgery (1 ed.), Wiley, pp. 133–141, doi:10.1002/9781119468189.ch16, ISBN   978-1-119-46808-0, S2CID   118065272 , retrieved 2023-02-17
  12. ↑ Zerbib, Frank (2018), Bardan, Eytan; Shaker, Reza (eds.), "Erosive Esophagitis", Gastrointestinal Motility Disorders, Cham: Springer International Publishing, pp. 91–99, doi:10.1007/978-3-319-59352-4_8, ISBN   978-3-319-59350-0 , retrieved 2023-02-17
  13. ↑ Zanetto, Alberto; Garcia-Tsao, Guadalupe (2020), Rahimi, Robert S. (ed.), "Gastroesophageal Variceal Bleeding Management", The Critically Ill Cirrhotic Patient, Cham: Springer International Publishing, pp. 39–66, doi:10.1007/978-3-030-24490-3_4, ISBN   978-3-030-24489-7, S2CID   204676084 , retrieved 2023-02-17
  14. ↑ Schroder, Jacob N.; Branch, Malcolm S. (2010), Pryor, Aurora D.; Pappas, Theodore N.; Branch, Malcolm Stanley (eds.), "Mallory–Weiss Syndrome", Gastrointestinal Bleeding, New York, NY: Springer New York, pp. 79–84, doi:10.1007/978-1-4419-1693-8_7, ISBN   978-1-4419-1692-1 , retrieved 2023-02-17


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