Causes of Gastrointestinal Bleeding in the Esophagus

Bleeding in the esophagus has several possible causes. Since some bleeds can be large and fatal, it's very important that you be evaluated by a healthcare provider for any gastrointestinal (GI) bleeding. And if you have any of the symptoms of acute GI bleeding, you should seek emergency treatment immediately. It's also important to know the symptoms of chronic GI bleeding and to see your healthcare provider if you experience them.

Doctor examining neck of patient
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Chronic GI bleeding, meaning the bleeding is slow, persistent or keeps recurring, tends to have less obvious symptoms, since it may come out in vomit or stool in microscopic amounts. However, chronic bleeding can lead to anemia, which is when you have fewer red blood cells than you should. Symptoms of anemia include:

  • Fatigue
  • Shortness of breath
  • Weakness
  • Pale skin
  • Feeling lightheaded or dizzy
  • Chest pain
  • Headaches
  • Cold hands and feet
  • Heart palpitations
  • Difficulty concentrating

If you do see blood in your vomit or stool, notice black, tarry stools, or vomit what looks like coffee grounds, you should see your healthcare provider as soon as possible.

Acute GI bleeding is severe and possibly sudden. If you have these symptoms, you need to seek emergency medical care:

  • Shortness of breath
  • Weakness
  • Blood in your stool
  • Blood in your vomit
  • Vomit that looks like coffee grounds
  • Fatigue
  • Feeling lightheaded or dizzy
  • Confusion
  • Disorientation
  • Diarrhea
  • Sleepiness

Acute bleeding can send you into shock. Symptoms of shock include:

  • Rapid pulse
  • Blood pressure drop
  • Unconsciousness
  • Not urinating often or at all


There are different causes of bleeding in the esophagus, depending on whether your bleeding is chronic or acute.

Causes of chronic bleeding include:

  • Inflammation (esophagitis): Stomach acid that backs up into your esophagus can cause inflammation, and this inflammation may lead to bleeding. If it's left untreated or goes on too long, you may vomit blood or a substance that looks like coffee grounds, which is an emergency situation.
  • Esophageal cancer: There are two types of esophageal cancer. Most of the length of the esophagus is lined with squamous cells, so if a malignant tumor grows here, it's called squamous cell cancer. The areas at the bottom of the esophagus, and where the esophagus joins the stomach, are lined with columnar cells. If a malignant tumor grows here, it's called adenocarcinomas.
  • Ulcers: An ulcer can form in your esophagus if stomach acid increases or the mucous layer that coats the lining of your digestive tract decreases. Causes of esophageal ulcers include the h. pylori bacteria and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, Motrin (ibuprofen), and Aleve (naproxen).

Causes of acute bleeding include:

  • Varices: These are abnormally enlarged veins located at the lower end of the esophagus. Esophageal varices are very rare and usually only occur in patients with severe liver disease like cirrhosis or other conditions that affect blood flow to the liver.
  • Tears: A tear in the lining of the esophagus that is usually caused by prolonged vomiting, but may also be caused by prolonged coughing or hiccuping. This is often called Mallory-Weiss syndrome, which is a disorder of the lower end of the esophagus caused by severe retching and vomiting and characterized by laceration associated with bleeding.
4 Sources
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  1. Kim BS, Li BT, Engel A, et al. Diagnosis of gastrointestinal bleeding: a practical guide for clinicians. World J Gastrointest Pathophysiol. 2014;5(4):467-78. doi:10.4291/wjgp.v5.i4.467

  2. Johnson-wimbley TD, Graham DY. Diagnosis and management of iron deficiency anemia in the 21st century. Therap Adv Gastroenterol. 2011;4(3):177-84. doi:10.1177/1756283X11398736

  3. Gaude GS. Pulmonary manifestations of gastroesophageal reflux disease. Ann Thorac Med. 2009;4(3):115-23. doi:10.4103/1817-1737.53347

  4. Kalva NR, Tokala MR, Dhillon S, et al. An unusual cause of acute upper gastrointestinal bleeding: acute esophageal necrosis. Case Rep Gastrointest Med. 2016;2016:6584363. doi:10.1155/2016/6584363

Additional Reading

By Sharon Gillson
 Sharon Gillson is a writer living with and covering GERD and other digestive issues.