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.