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Drug-induced hematemesis
Other Resources UpToDate PubMed

Drug-induced hematemesis

Contributors: Michael W. Winter MD, Paritosh Prasad MD
Other Resources UpToDate PubMed


Hematemesis is the vomiting of blood. This is suggestive of gastrointestinal hemorrhage proximal to the ligament of Treitz. It can present either as emesis of bright red blood, a blood clot, or coffee-ground emesis. When medications lead to hematemesis, it is usually in the setting of mucosal injury or ulcer formation, both of which have a propensity to bleed.

Common medication culprits are NSAIDs, which can predispose to ulcer formation, and chemotherapeutic agents, which frequently cause nausea and emesis leading to mucosal injury and subsequent hematemesis.

Pill-induced esophagitis can cause hematemesis. Particular antibiotics (doxycycline, tetracycline, clindamycin), potassium chloride, bisphosphonates, and NSAIDs are often associated with pill-induced esophagitis. Esophageal dysmotility or anatomic obstruction (ie, strictures, rings, webs) can predispose to pill-induced esophagitis and esophageal ulcer formation.

For a more exhaustive list of medications associated with drug-induced hematemesis, see Drug Reaction Data below.

Hematemesis is treated with fluid resuscitation, antacid suppression (proton pump inhibitors), and blood transfusions if necessary. Hematemesis often requires an endoscopy to evaluate for sources amenable to endoscopic therapy.


K92.0 – Hematemesis

196757008 – Drug-induced gastrointestinal disturbance

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Mallory-Weiss syndrome
  • Esophageal or gastric Esophageal varices – typically in cirrhotic patients
  • Esophagitis
  • Gastritis
  • Esophageal, Gastric ulcer, or Duodenal ulcer – risk factors include Helicobacter pylori infection, NSAID use, smoking, and surgical anastomoses
  • Crohn disease
  • Behçet syndrome
  • Esophageal carcinoma or Gastric cancer or bleeding polyp
  • Dieulafoy lesion
  • Arteriovenous malformation
  • Epistaxis or oropharyngeal bleeding (see Drug-induced epistaxis)
  • Zollinger-Ellison syndrome
  • Bleeding disorders such as Hemophilia A, Hemophilia B, and Von Willebrand disease
  • Disseminated intravascular coagulation
  • Aortoenteric fistula

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:01/23/2018
Last Updated:08/31/2023
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Drug-induced hematemesis
A medical illustration showing key findings of Drug-induced hematemesis : Hematemesis
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