The vomiting of blood, even small amounts, warrants a prompt visit to a doctor and has numerous potential causes.
Can a hiatal hernia ever be one?
A common hiatal hernia cannot lead to cancer, a stomach rupture or some other life-threatening situation.
Do not confuse the more common sliding hiatal (or hiatus) hernia with the more serious and much larger paraesophageal hernia, which can lead to serious complications.
The paraesophageal hernia, which is actually a type of hiatus hernia, can cause vomiting. So can the sliding type.
It’s also quite possible to have two conditions at the same time: a hiatal hernia and an unrelated pathology that causes vomiting.
The issue then becomes: If you notice blood in your vomitus, would it necessarily be caused by a hiatus hernia?
“Vomiting blood implies a source of bleeding in the upper gastrointestinal tract (esophagus, stomach or first part of the duodenum),” begins Santosh Sanagapalli, MD, a consultant gastroenterologist, endoscopist and specialist in esophageal disorders.
“Small amounts of bleeding from these regions will not cause vomiting of blood, as small amounts will quickly pass through the stomach and into the intestines (this may cause dark stools).
“However, if there is a large amount of bleeding in the upper gastrointestinal tract, then this may quickly fill up the stomach and induce vomiting of blood.
“The vast majority of hiatal hernias do not bleed. On occasion, very large hiatal hernias can bleed very slowly due to the presence of Cameron’s erosions with the hiatal hernia.
“Cameron’s erosions are small, shallow breaks in the lining of the stomach within the hiatal hernia that are thought to occur due to friction between the tissue on sides of the hernia.
“The bleeding from Cameron’s erosions is very slow and rarely would even be visible in the stool.
“It can, however, cause iron deficiency anemia due to chronic, microscopic blood loss.
“Hiatal hernias, even large ones, would never cause significant bleeding leading to vomiting of blood.”
You Have a Hiatal Hernia Plus Blood in Your Vomit
The blood would most likely be from another cause, while the upchucking could be from your hernia.
For example, you may, by coincidence, have a large peptic ulcer that’s bleeding. A bleeding ulcer can cause blood in one’s vomitus.
Other causes of upchucking blood include a torn blood vessel, acute liver failure, benign stomach tumor and side effect of aspirin.
Blood in the vomitus may be bright red, but it may also appear black or brown, resembling coffee grounds.
Vomitus that’s brown but smoother in appearance rather than having what looks like coffee grounds is most likely from recent consumption of a tomato product, combined with bile acids (tomato mixed with green equals brown).
An upper endoscopy will determine if you have a bleeding ulcer anywhere along the GI tract.
Dr. Sanagapalli is a gastroenterologist and director of the Esophageal Disorders Center at St Vincent’s Hospital, Darlinghurst. He performs diagnostic and therapeutic endoscopic procedures, and enjoys providing comprehensive and holistic care to patients with a wide variety of disorders affecting the gastrointestinal tract.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.