Vomit : Causes, Symptoms, Diagnosis & Treatment

Last Updated: 15/09/2022

Vomiting is an involuntary reflex eruption of the contents of the stomach, less often the intestines through the esophagus, pharynx, oral cavity or nasal passages. Physiologically, the gag reflex performs a protective function, ensuring the removal of toxic substances and metabolites from the body. It is observed in case of poisoning, intestinal infections, diseases of the gastrointestinal tract, cerebral pathology, acute and terminal conditions, endogenous intoxications, etc. It is diagnosed using endoscopy, ultrasound, radiography, CT, MRI of various organs and systems, electrophysiological studies, laboratory tests. To alleviate the patient's condition, sedatives and antiemetics are used.

general characteristics

At the time of vomiting, the patient experiences an uncontrolled contraction of the abdominal muscles and diaphragm, leading to a sharp release of gastric, and in some cases, intestinal contents. The secreted masses may contain remnants of undigested food, mucous, bloody and bile inclusions, and other pathological impurities. Often an attack is preceded by nausea, profuse salivation, weakness, sweating. Perhaps dizziness, unsteadiness of gait, palpitations. After an episode of vomiting, a sour, bitter, putrid taste or smell remains in the mouth and sometimes in the nasal passages.

From the outside, the patient looks confused, pale, sweat drops are often visible on the forehead. The appearance of vomiting should always be regarded as a threatening condition in which a medical examination is necessary. If after the discharge of the vomit the patient's condition has improved, a visit to the therapist or family doctor may be planned. If indomitable vomiting occurs, blood, bile, mucus and feces are detected in it, a symptom is combined with hyperthermia, intense pain of any localization, diarrhea, stupor, disorientation and convulsions, it is necessary to call an ambulance.

Development mechanism

Vomiting is the result of a complex reflex response in which the uncontrolled contraction and relaxation of various muscle groups results in the release of gastric chyme. The reflex is activated by impacts on different links of the neural circuit. Neuroreceptors that stimulate the vomiting center are located in the pharynx, stomach, intestines, bile ducts, peritoneum, coronary and mesenteric vessels, and a number of other organs. Their activation is caused by irritation of the mucous membranes with bacteria toxins, the release of bioactive substances, pressure, vasospasm, and other visceral effects.

Impulses from peripheral receptors arrive through the vagal and sympathetic fibers to the vomiting center of the medulla oblongata. Neurons of the reticular formation can also be activated by the direct influence of toxic substances on the chemosensitive zone of the bottom of the fourth cerebral ventricle, an increase in intracranial pressure. Less commonly, the gag reflex is triggered by impulses from the vestibular apparatus, the impact of mental stimuli, or intense pain of any origin.

The motor part of the reflex arc is represented by the V, IX, X pairs of cranial nerves that innervate the soft palate, larynx, pharynx, esophagus, stomach and diaphragm, spinal nerves that provide contraction of the striated intercostal muscles and the muscles of the anterior abdominal wall. Since the vomiting center is located next to the cough, vasomotor, respiratory and other autonomic centers, their simultaneous activation causes hypersalivation, a drop in blood pressure, blanching and other parasympathetic reactions.

When efferent impulses are received against the background of a deep breath, the diaphragm descends, the epiglottis closes the entrance to the respiratory tract, the larynx and palate rise, preventing the chyme from being thrown into the trachea, bronchi and lungs. The tension of the diaphragmatic and abdominal muscles against the background of compression of the pylorus and relaxation of the cardia provides an increase in intra-abdominal and intra-gastric pressure, which ends with an attack of vomiting. In some conditions, antiperistaltic movements of the intestinal wall occur, due to which the contents of the intestine enter the stomach, and then into the vomit.



When systematizing the clinical variants of a symptom, its connection with gastrointestinal diseases, the frequency of manifestation, the mechanism of development, and the characteristics of vomit are taken into account. Vomiting associated with diseases of the digestive tract is called primary, which arose against the background of other pathological conditions - secondary. Depending on the leading development mechanism, there are:

  • Central vomiting . It is observed in the presence of cerebral pathology (inflammation of the medulla and membranes, increased intracranial pressure in head injuries, brain tumors). With neurosis, panic attacks, migraine, hyperthermia, the symptom is associated with dysfunction of the central links of autonomic regulation. Often occurs repeatedly and does not alleviate the patient's condition.
  • Hemotoxic vomiting . It is caused by irritation of the receptor zone of the medulla oblongata during the circulation of various exo- and endotoxins in the blood. It is found in case of poisoning with medicines, poisonous products and reagents. It is an unfavorable sign of intoxication in the presence of severe and terminal conditions (malignant tumors, renal, liver failure).
  • Reflex vomiting . Caused by irritation of the visceral receptors of the gag reflex arc in various organs and tissues. It most often develops in the pathology of the gastrointestinal tract, but can be provoked by pathological afferentation in diseases of the upper respiratory tract, heart, lungs, bronchi and female reproductive sphere. Variants of reflex vomiting are psychogenic and vestibular.

A symptom can appear once (usually against the background of food errors, poisoning, intestinal infections), repeatedly (several times within a short time up to indomitable vomiting in severe intoxications and cerebral disorders), periodically (in diseases of the gastrointestinal tract, other chronic pathology). From a diagnostic point of view, it is important to consider the nature of the vomit. According to the features of impurities, there are variants of vomiting of undigested food, blood (scarlet and coffee grounds), bile, foamy mucus, intestinal contents.

Causes of vomiting

Causes of vomiting of bile

Vomit with an admixture of bile has a greenish color, after vomiting a bitter taste is felt in the mouth, a yellow-green coating remains on the tongue. Vomiting of bile can be a sign of the following pathological conditions:

  • Diseases of the hepatobiliary system : cholelithiasis, cholecystitis and cholangitis, biliary dyskinesia.
  • Duodeno - gastric reflux : acute and chronic duodenitis, duodenal stenosis, functional dyspepsia.
  • Pathologies of the pancreas : chronic pancreatitis, cysts and tumors.
  • Worm infestations : opisthorchiasis, giardiasis.
  • Acute surgical diseases : the initial phase of peritonitis and acute intestinal obstruction, appendicitis.
  • Alcohol intoxication .

Causes of food vomiting

Nausea and vomiting may occur at various times after eating. In the vomit, the remnants of what was eaten are clearly visible. The most common causes of food vomiting are:

  • Poisoning : food poisoning, salmonellosis, escherichiosis, etc.
  • Diseases of the stomach : acute gastritis, pyloric stenosis, neoplasms.
  • Damage to the esophagus: various types of dyskinesia, congenital or acquired stenosis, ulcers.
  • Other gastroenterological pathology: duodenal stenosis, afferent loop syndrome.

Causes of vomiting blood

Vomiting masses such as "coffee grounds" or with an admixture of fresh blood always indicate bleeding from the gastrointestinal tract. Vomiting blood occurs in the following diseases of the digestive tract:

  • Peptic ulcer : bleeding from the bottom of the ulcer, Zollinger-Ellison syndrome.
  • Gastritis: erosive, hemorrhagic.
  • Pathology of the gastroduodenal zone: diverticula, acute expansion of the stomach, erosive bulbitis.
  • Tumors of the stomach.
  • Diseases of the esophagus: Mallory-Weiss syndrome, acute esophagitis, esophageal cancer.
  • Portal hypertension: bleeding from varicose veins.
  • Complications of pharmacotherapy: long-term use of NSAIDs, anticoagulants, corticosteroids.
  • Rare causes: hemorrhagic syndromes, neurotoxicosis, profuse nosebleeds.

Causes of vomiting during pregnancy

Nausea and vomiting in pregnant women can occur both due to the gestation itself and changes occurring in the body, and in the case of the development of various pathologies. Possible reasons:

  • Early toxicosis .
  • Gastrointestinal diseases : GERD, gastritis and duodenitis, functional indigestion, hiatal hernia.
  • Specific pathology of pregnancy : cholestasis, hypothyroidism, polyneuropathy of pregnant women.

Causes of fecal vomiting

Vomiting of intestinal contents is always a sign of a surgical pathology that requires an urgent response. Fecal vomiting can occur in the following conditions:

  • Intestinal obstruction : obstructive and strangulation forms.
  • End-stage peritonitis .
  • Intestinal-gastric fistulas.


The development of vomiting is most often due to diseases of the gastrointestinal tract, so a gastroenterologist is involved in a comprehensive examination. Diagnostic search involves the study of the structural and functional features of the digestive system, the exclusion of concomitant pathologies. The most informative for establishing the causes of vomiting:

  • Endoscopy. Using the method of visualization of the mucous membrane of the upper gastrointestinal tract, a specialist can see inflammatory changes, foci of epithelial destruction, and volumetric neoplasms. If necessary, during endoscopy, a biopsy of individual sections of the mucosa is performed for subsequent cytomorphological diagnosis.
  • X-ray methods . X-ray with contrast is highly informative in organic diseases, which are often manifested by vomiting. On the pictures you can detect deformation of the contours of the esophagus or stomach, pathological shadows. The motor function of the digestive tract is judged by the speed of the contrast advance.
  • Ultrasound . Plain ultrasound of the abdominal cavity is prescribed for all patients with dyspeptic disorders as a screening method. Sonography allows you to identify non-specific signs of the inflammatory process, changes in the organs of the hepatobiliary system. The method is used to diagnose pathologies of the gastrointestinal tract in pregnant women at any time.
  • Esophageal manometry . Measurement of esophageal pressure is performed to exclude dyskinesias and disruption of the muscle sphincters, as the main cause of vomiting. If hyperacid diseases of the stomach are suspected, daily pH-metry is prescribed. Intraesophageal pH determination is indicated for verification of GERD.
  • Laboratory tests . In the coprogram, characteristic changes can be detected: undigested food components, the presence of fecal elastase. Stool culture is recommended to rule out intestinal infections. They also evaluate the indicators of a biochemical blood test: acute phase proteins, levels of bilirubin and liver enzymes.

In case of damage to the hepatobiliary system, duodenal sounding with microscopic examination of bile, targeted ultrasound of the liver and gallbladder is recommended. If vomiting is caused by an infectious process, serological tests are performed to determine the type of pathogen and the amount of specific antibodies. A gynecologist is required to examine pregnant women. After all organic causes have been ruled out, autonomic examination may be required.

With profuse vomiting, oral or parenteral rehydration is performed



Help before diagnosis

You can reduce discomfort and the number of vomiting with the help of diet therapy: patients are advised to give up fatty foods, a large number of pastries, smoked meats. To reduce the load on the gastrointestinal tract, food should be taken 5-6 times a day, in small portions. It is permissible to use herbal remedies (green tea, decoctions of chamomile and mint), enterosorbents. Repeated vomiting, combined with abdominal pain or other symptoms, is an indication for visiting a doctor who will determine its cause and select the optimal treatment regimen.

Conservative therapy

After verifying the cause of vomiting, patients are prescribed complex treatment using medications, physiotherapy and diet therapy. Medical tactics involves the use of therapeutic nutrition, the list of permitted products depends on the disease. In case of pathologies of the pancreas, fasting for several days is sometimes advised to create a functional rest of the organ. For the treatment of patients with complaints of vomiting, the following groups of drugs are indicated:

  • Prokinetics . Means that accelerate the motility of the gastrointestinal tract, stimulate the passage of food through the intestines, reduce the distension of the stomach and reduce the frequency of vomiting. Due to the increase in the tone of the lower esophageal sphincter, prokinetics are used to treat vomiting in GERD and esophageal dyskinesias.
  • Antisecretory drugs . Gagging can occur when the gastric mucosa is irritated with hydrochloric acid, therefore, H2-histamine receptor blockers and proton pump inhibitors are used to neutralize it. Means are prescribed for long-term use of NSAIDs to prevent hematemesis.
  • Antibiotics . Drugs with antibacterial properties are indicated for vomiting caused by severe intestinal infections. Therapy is selected empirically, taking into account the alleged pathogen, after receiving the results of bacteriological culture, the treatment regimen is corrected.
  • enzyme preparations . Medicines that contain digestive enzymes improve the digestion of food. This reduces the frequency of regurgitation of rotten vomit in chronic pancreatitis, pathologies of the biliary tract.
  • Antiemetics . Strong drugs that affect the vomiting center in the brain are indicated for repeated painful vomiting. Medicines have severe side effects, so they are used only in difficult situations.


Repeated vomiting of bile or intestinal contents can serve as a symptom of acute surgical diseases of the gastrointestinal tract, which requires emergency surgical intervention. The type of operation depends on the specific disease: debridement and drainage of the abdominal cavity, resection of a section of the intestine, elimination of intestinal obstruction, cholecystectomy can be performed. Pyloroplasty is recommended for decompensated pyloric stenosis. In oncopathology, the surgical method is combined with radiation therapy and chemotherapy.