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Coffee ground vomitus refers to a particular appearance of
vomit Vomiting (also known as emesis, puking and throwing up) is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenteritis, pregna ...
. Within organic
heme Heme (American English), or haem (Commonwealth English, both pronounced /Help:IPA/English, hi:m/ ), is a ring-shaped iron-containing molecule that commonly serves as a Ligand (biochemistry), ligand of various proteins, more notably as a Prostheti ...
molecules of
red blood cell Red blood cells (RBCs), referred to as erythrocytes (, with -''cyte'' translated as 'cell' in modern usage) in academia and medical publishing, also known as red cells, erythroid cells, and rarely haematids, are the most common type of blood cel ...
s is the element
iron Iron is a chemical element; it has symbol Fe () and atomic number 26. It is a metal that belongs to the first transition series and group 8 of the periodic table. It is, by mass, the most common element on Earth, forming much of Earth's o ...
, which oxidizes following exposure to
gastric acid Gastric acid or stomach acid is the acidic component – hydrochloric acid – of gastric juice, produced by parietal cells in the gastric glands of the stomach lining. In humans, the pH is between one and three, much lower than most other a ...
. This reaction causes the vomitus to look black like coffee grounds.


Causes

Esophagitis 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 stoma ...
,
esophageal varices Esophageal varices are extremely Vasodilation, dilated sub-mucosal veins in the lower third of the esophagus. They are most often a consequence of portal hypertension, commonly due to cirrhosis. People with esophageal varices have a strong tendenc ...
,
gastritis 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 (see dyspepsia). Othe ...
,
cirrhosis Cirrhosis, also known as liver cirrhosis or hepatic cirrhosis, chronic liver failure or chronic hepatic failure and end-stage liver disease, is a chronic condition of the liver in which the normal functioning tissue, or parenchyma, is replaced ...
or gastric ulcers for example, may bleed and produce coffee-ground vomitus. When unaccompanied by melena, hematemesis or a fall in
hemoglobin Hemoglobin (haemoglobin, Hb or Hgb) is a protein containing iron that facilitates the transportation of oxygen in red blood cells. Almost all vertebrates contain hemoglobin, with the sole exception of the fish family Channichthyidae. 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 Bowel obstruction, also known as intestinal obstruction, is a mechanical or Ileus, functional obstruction of the Gastrointestinal tract#Lower gastrointestinal tract, intestines which prevents the normal movement of the products of digestion. Ei ...
or ileus, that can cause oxidised food material to be vomited. Vomiting iron supplements can also mimic coffee grounds to the untrained eye. Diseases such as
Ebola Ebola, also known as Ebola virus disease (EVD) and Ebola hemorrhagic fever (EHF), is a viral hemorrhagic fever in humans and other primates, caused by ebolaviruses. Symptoms typically start anywhere between two days and three weeks after in ...
, yellow fever, viral hepatitis, haemophilia B, fatty liver disease and cancers of
stomach The stomach is a muscular, hollow organ in the upper gastrointestinal tract of Human, humans and many other animals, including several invertebrates. The Ancient Greek name for the stomach is ''gaster'' which is used as ''gastric'' in medical t ...
,
pancreas The pancreas (plural pancreases, or pancreata) is an Organ (anatomy), organ of the Digestion, digestive system and endocrine system of vertebrates. In humans, it is located in the abdominal cavity, abdomen behind the stomach and functions as a ...
,
esophagus The esophagus (American English), oesophagus (British English), or œsophagus (Œ, archaic spelling) (American and British English spelling differences#ae and oe, see spelling difference) all ; : ((o)e)(œ)sophagi or ((o)e)(œ)sophaguses), c ...
and, rarely, retrograde jejunogastric intussusception might also be the reason behind coffee-ground vomitus. When attributed to peptic inflammation, use of
nonsteroidal anti-inflammatory drug Non-steroidal anti-inflammatory drugs (NSAID) are members of a Indication (medicine), therapeutic drug class which Analgesic, reduces pain, Anti-inflammatory, decreases inflammation, Antipyretic, decreases fever, and Antithrombotic, prevents bl ...
s (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 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 ...
, ''
Helicobacter pylori ''Helicobacter pylori'', previously known as ''Campylobacter pylori'', is a gram-negative, Flagellum#bacterial, flagellated, Bacterial cellular morphologies#Helical, helical bacterium. Mutants can have a rod or curved rod shape that exhibits l ...
'' 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. Oxidized blood from an upper gastrointestinal bleed can also be excreted in stool. It produces blackened, "tarry" stools known as melena.


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 The esophagus (American English), oesophagus (British English), or œsophagus (Œ, archaic spelling) (American and British English spelling differences#ae and oe, see spelling difference) all ; : ((o)e)(œ)sophagi or ((o)e)(œ)sophaguses), c ...
,
stomach The stomach is a muscular, hollow organ in the upper gastrointestinal tract of Human, humans and many other animals, including several invertebrates. The Ancient Greek name for the stomach is ''gaster'' which is used as ''gastric'' in medical t ...
, and
duodenum The duodenum is the first section of the small intestine in most vertebrates, including mammals, reptiles, and birds. In mammals, it may be the principal site for iron absorption. The duodenum precedes the jejunum and ileum and is the shortest p ...
. Numerous studies have suggested that urgent endoscopy is not required for coffee ground emesis alone. 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. While endoscopic visualization may be sufficient for diagnosis, a
biopsy A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, an interventional radiologist, or an interventional cardiology, interventional cardiologist. The process involves the extraction of sampling (medicine), sample ...
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.


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 Proton-pump inhibitors (PPIs) are a class of medications that cause a profound and prolonged reduction of gastric acid, stomach acid production. They do so by irreversibly inhibiting the stomach's H+/K+ ATPase, H+/K+ ATPase proton pump. The body ...
(PPI) or H2-blockers, or through conventional
antacid An antacid is a substance which neutralization (chemistry), neutralizes gastric acid, stomach acidity and is used to relieve heartburn, indigestion, or an upset stomach. Some antacids have been used in the treatment of constipation and diarrhe ...
s. 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 Clarithromycin, sold under the brand name Biaxin among others, is an antibiotic used to treat various bacterial infections. This includes strep throat, pneumonia, skin infections, '' H. pylori'' infection, and Lyme disease, among others. Clari ...
and amoxicillin are commonly used in tandem, but antibiotic regiments may vary based on organism susceptibility, side effects, and patient
allergies Allergies, also known as allergic diseases, are various conditions caused by hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include Allergic rhinitis, hay fever, Food allergy, food al ...
. 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. 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. 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. Esophageal lacerations ( Mallory-Weiss tears) are mostly self-limiting, though the majority require
blood transfusion Blood transfusion is the process of transferring blood products into a person's Circulatory system, circulation intravenously. Transfusions are used for various medical conditions to replace lost components of the blood. Early transfusions used ...
s to compensate for blood loss. Endoscopic interventions, including
epinephrine Adrenaline, also known as epinephrine, is a hormone and medication which is involved in regulating visceral functions (e.g., respiration). It appears as a white microcrystalline granule. Adrenaline is normally produced by the adrenal glands a ...
injections, clipping, and
cauterization Cauterization (or cauterisation, or cautery) is a medical practice or technique of burning a part of a body to remove or close off a part of it. It destroys some tissue in an attempt to mitigate bleeding and damage, remove an undesired growth, o ...
may be utilized if needed.


References


External links

{{Digestive system and abdomen symptoms and signs Vomiting Digestive disease symptoms