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Blood in vomit from bulimia: esophagus damage caused by throwing up

Bulimia nervosa (BN) is a serious eating disorder that can have numerous medical complications if left untreated. Perhaps one of the most alarming of these for the person suffering from the eating disorder is the appearance of blood after self-induced vomiting.

If this has happened to you, you're probably concerned about where the blood is coming from and if this is something that can be treated quickly and effectively.

This article will explain what causes blood in vomit, bulimia nervosa's role in the issue, how the problem can be treated, and where you or your loved one can get help with disordered eating behaviors.

 minutes read
Last updated on 
June 6, 2023
June 6, 2023
Person with bulimia
In this article

What causes bulimia blood in vomit?

Bulimia nervosa is an eating disorder characterized most commonly by the purging behavior of self-induced vomiting, which usually occurs after an episode of binge eating. Repeated and recurring episodes of forced vomiting can be extremely harsh on the body, particularly the esophagus and the throat.1

The esophagus is the tube of muscle that connects the mouth to the stomach. The blood vessels in the esophagus are thinner than those in other parts of the body, so they are more prone to rupturing through excessive pressure.

Regularly, forcing large amounts of food back up the esophagus increases the pressure on the blood vessels, causing them to swell and rupture, resulting in bleeding. This is what leads to the appearance of bright red blood in vomit, and it is known as esophageal varices or swollen veins.1

The signs and symptoms of esophageal varices are not just limited to hematemesis (blood in vomit). They also include:1
  • Bloody stools
  • Black stools
  • Abdominal pain
  • Lightheadedness
  • Fainting or shock due to blood loss
  • FatigueSore throat

Repeated episodes of forceful and frequent vomiting can also cause tears in the lining of your esophagus, known as Mallory-Weiss syndrome. This, too, results in bleeding, which can be severe and life-threatening.2

The symptoms of Mallory-Weiss syndrome are similar to those of esophageal varices, with the addition of diarrhea and vomit that is bright red or looks like coffee grounds.3

When to seek medical treatment for bleeding

If you or someone you know has experienced blood in their vomit after a purging episode, it's important to seek immediate medical treatment. 

Esophageal varices or Mallory-Weiss syndrome should never be taken lightly. Even just a small amount of blood in your vomit could be an indicator of a more serious bleed within the esophagus or other part of the gastrointestinal system, which will need to be controlled as soon as possible to prevent further complications. 

In these rare cases of severe internal bleeding, you may experience a drop in blood pressure, a rapid pulse, difficulty producing urine, and even shock.2

How long before bulimia damages the esophagus?

It's hard to say how long it takes for self-induced vomiting to cause damage to the esophagus. The severity of symptoms and time of onset depends largely on the sensitivity of the individual, as opposed to the duration or severity of their purging behavior.6

What's certain is that repeated vomiting can introduce stomach acid to the esophageal lining, leading to a hoarse voice, heartburn, thick mucous over the larynx, and, in severe cases, esophageal ruptures. Other complications such as achalasia, where the muscles of the lower esophagus are unable to relax, and esophageal spasms are also possible, though these, too, have been found to occur independent from the duration or severity of someone's compensatory behavior.6

Treating damage to the esophagus and throat caused by bulimia 

Once you've had one episode of bleeding while purging, your risk of more bleeding greatly increases.4 If you have bulimia nervosa and don't give your body enough time to heal or treat the esophageal varices effectively, you're likely to experience recurrent bleeding.1

To address acute damage to the esophagus and bleeding, doctors will typically use a combination of medications and treatments, including:4

  • Beta-blockers, a type of medication that reduces blood pressure
  • Endoscopic band ligation, which is a procedure that uses elastic bands to restrict bleeding veins
  • Medications to slow the blood flow to the veins of the esophagus
  • Applying pressure to the bleeding veins, for example, with an inflated balloon in the esophagus, known as a balloon tamponade
  • Blood transfusions and administration of clotting factors to restore blood volume and stop the bleeding.

The best way to treat and prevent esophageal varices and Mallory-Wiess syndrome is to address the underlying cause, which in this case is bulimia nervosa

Early treatment and intervention in cases of bulimia nervosa can prevent further damage resulting from esophageal bleeding and other complications of the eating disorder. Additionally, professional help from a multidisciplinary team will help a person to heal mentally and medically.

Help for bulimia nervosa

We know it can be uncomfortable to seek help for your bulimia and that binging and purging behaviors are often accompanied by feelings of shame and embarrassment. There is no shame in having bulimia. Many other people have been in the same position as you, and they have been successfully treated for their eating disorders. Taking that first step, by asking for help, is very important and takes courage.

Treatment for bulimia is multifaceted and depends on the behaviors involved and the underlying causes of the disorder. However, intervention typically involves the combination of psychotherapy, nutritional counseling, and, in some cases, antidepressants to treat co-occurring psychological disorders.5

If more structure and supervision is needed to engage in the treatment, inpatient or residential treatment may be required to provide you with round-the-clock support and care.

Call us today to learn about our virtual care program for treating bulimia nervosa.
Call (866) 293-0041


Psychotherapy, such as cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT), will help you discover the underlying causes for your disordered thoughts and eating behaviors whilst also working towards changing these habits for healthier coping strategies.

Other therapies provided may include interpersonal therapy, group therapy, and family therapy, which teaches loved ones and family members about bulimia and how best to support someone during treatment.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.


  1. Denholm, M., & Jankowski, J. (2011). Gastroesophageal reflux disease and bulimia nervosa - a review of the literature. Diseases of the Esophagus, 24(2), 79–85.
  2. Hay, P. (2011). New insights into the prevention and treatment of bulimia nervosa. InTech. Retrieved May 21, 2023.
  3. Mallory-Weiss tear. Johns Hopkins Medicine. (2019, November 19). Retrieved April 29, 2022.
  4. Mayo Foundation for Medical Education and Research. (2021, February 20). Esophageal varices. Mayo Clinic. Retrieved April 29, 2022.
  5. Harrington, B. C., Jimerson, M., Haxton, C., & Jimerson, D. C. (2015, January 1). Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. American Family Physician.
  6. Forney, K. J., Buchman-Schmitt, J. M., Keel, P. K., & Frank, G. K. (2016). The medical complications associated with purging. The International Journal of Eating Disorders, 49(3), 249–259. 


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Further reading

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