Throwing Up Stomach Acid: 3 Main Causes & Treatments.

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Quick Insights:

  • Vomiting of stomach acid occurs due to either vomiting on an empty stomach or repeated vomiting in a short period.
  • The three most common causes of vomiting stomach acid are:
    • Acute gastroenteritis or food poisoning.
    • An attack of gastritis or peptic ulcer disease.
    • An attack of GERD (acid reflux).
  • Other less common causes include drug-induced vomiting, brain disorders, chemotherapy, psychiatric disorders, and endocrinal disease.
  • See a doctor if there are unable to detect the cause or if there are any signs of dehydration, bloody vomit, or altered consciousness level.

How Does throwing up stomach acid occur?

Your stomach helps to squeeze and mix the food you eat. It also secretes gastric juice.

Gastric juice (stomach acid) is composed of (reference:

  • Water.
  • Mucus.
  • Hydrochloric acid (HCL).
  • Pepsin (an enzyme that digests protein).
  • Intrinsic factor.
  • And some electrolytes.

Most people vomit food mixed with stomach acid (gastric juice). However, throwing up pure stomach acid (without food) usually occurs on two occasions:

  • Repeated severe attacks of vomiting: Vomiting of food occurs at first. Later, patients may vomit stomach acid. This is common in severe attacks of gastroenteritis (especially in infants and toddlers).
  • Vomiting after fasting: If you vomit for more than 4-6 hours, you will probably vomit stomach acid as the stomach becomes empty during fasting. A common example is vomiting first thing in the morning (because of fasting overnight).

Below, you will learn about the symptoms and treatments of the most frequent causes of throwing up stomach acid.

1. An attack of gastritis or peptic ulcer disease.

Gastritis is a chronic inflammation of the lining of your stomach. It is most commonly caused by a bacteria called H. pylori or nonsteroidal anti-inflammatory drug abuse.

In some people with gastritis, the severe inflammation may cause a sore (breakdown) in the stomach lining or the duodenum leading to peptic ulcer disease.

Both gastritis and peptic ulcer disease cause recurrent attacks of epigastric pain, nausea, and vomiting.

In some cases, the attack may become severe, leading to repeated vomiting or vomiting during fasting, which leads to throwing up stomach acid.

Symptoms:

  • Upper stomach pain is sharp and continuous in the form of heaviness or gnawing.
  • Related to meals: the pain usually starts shortly after meals (especially heavy or fatty meals).
  • The pain can be referred to as the upper-middle back.
  • Associated with nausea, lost appetite, or vomiting.
  • Vomiting can be severe, occurring on an empty stomach (vomiting yellow bitter liquid) and with or without eating (even in the morning). In severe cases, an ulcer can occur (peptic ulcer).
  • Gastritis can be chronic (the pain comes and goes for long periods) or acute (with sudden sharp upper abdominal pain).
  • Patients with peptic ulcer disease have the same symptoms but:
    • Nausea and vomiting are more common.
    • Bleeding ulcers can lead to the vomiting of blood (hematemesis).
    • Bleeding can also occur without vomiting blood. The presentation may be dark tarry stools (melena).
    • Also, the bleeding can be scanty over long periods. This leads to anemia (with fatigue, dizziness, and shortness of breath).

How to stop throwing up bile from gastritis or PUD?

  • Temporarily hold heating to let the stomach settle down.
  • Try over-counter-antiemetic medications such as Bismuth subsalicylates (Peto Bismol) or Dimenhydrinate (Dramamine).
  • Try an OTC PPIs such as Omeprazole (Prilosec) or Esomeprazole (Nexium).
  • Avoid fatty, greasy, spicy foods and large meals.
  • Avoid alcohol and caffeine.
  • Avoid analgesic medications such as Advil or meloxicam.
  • Call your doctor if the vomiting is severe, very frequent, or contains blood.
  • Call your doctor if you have black stools (melena).

2. Gastroenteritis or Food poisoning.

Gastroenteritis is an acute infection of your stomach and the intestines. It is most commonly caused by stomach viruses such as norovirus or rotavirus.

Gastroenteritis can also occur due to bacterial, protozoal, or parasitic infections.

Food poisoning is any illness caused by eating/drinking food/beverages contaminated with infectious agents or toxins.

Food poisoning is also mainly caused by bacteria or viruses (such as salmonella, E. coli, norovirus, etc.).

Both gastroenteritis and food poisoning can be severe and cause frequent vomiting.

Symptoms:

The symptoms of viral gastroenteritis include:

  • Sudden onset of loose or watery diarrhea (more than three motions per day).
  • Sudden onset of vomiting (it is more severe in infants and toddlers). The vomiting can be very frequent, leading to vomiting of yellowish stomach acid when it occurs on an empty stomach).
  • The symptoms occur without fever or with low-grade unnoticeable fever.
  • Nausea without vomiting can also be present.
  • Fatigue and muscle aches.
  • Severe lower abdominal cramps that partially improve after bowel motions.

The course of symptoms:

  • The vomiting and diarrhea start suddenly.
  • They typically improve within one to three days.
  • In more than 99% of cases, signs don’t exceed one week.
  • If the vomiting and diarrhea (with or without fever) last for more than a week, you should see a doctor, even if the symptoms are mild.

Symptoms of bacterial gastroenteritis and food poisoning are often severe; the following table illustrates the main differences between viral and bacterial infections of the gut:TypeViral GastroenteritisBacterial GE1- SiteUsually affects the stomach and small intestine.Affects the colon.2- Diarrhea.Watery, mildBloody, mucoid, more severe.3-VomitingUsually presentRarely occur.4- CrampsmildSevere5- FeverLow gradeHigh grade6- AnorexiaMild or not presentsevere.

Treatments:

  • Most cases of viral gastroenteritis (stomach flu) are typically mild and self-limiting within a few days.
  • Bacterial gastroenteritis and food poisoning are often more severe, with persistent vomiting, severe diarrhea, and higher fever. So, it usually needs treatment.
  • Stop eating solid foods for a few hours (give your stomach a rest, particularly with persistent vomiting of stomach acid).
  • Suck on ice chips or take small sips of water.
  • Try an OTC anti-emetic and anti-diarrhea such as Pepto Bismol.
  • Rest.
  • Avoid nauseating and heavy foods such as caffeine, fatty, and spicy foods.
  • Try OTC anti-diarrhea medicines such as Immodium A-D.
  • Children who frequently vomit stomach acid need a doctor’s visit; an oral rehydration solution is often necessary.
  • Antipyretics and antispasmodics also help.

3. An attack of acid reflux (GERD).

GERD (gastroesophageal reflux disease) occurs when your stomach acid reflux upwards from the stomach to the esophagus. It occurs due to abnormalities in the sphincter between the esophagus and the stomach (the lower esophageal sphincter or LES).

GERD is one of the most common diseases. It affects approximately [20% of western adults](https://www.ncbi.nlm.nih.gov/books/NBK441938/#:~:text=GERD is one of the,between 18.1%25 to 27.8%25.).

The main two causes are:

  • Failure of the LES to close (low muscle tone of the sphincter).
  • Hiatal hernia (herniation of a part of the stomach into the chest through the opening of the esophagus in the diaphragm).

Patients with GERD often suffer from recurrent heartburn and food or acidic material regurgitation. In severe cases (especially those with hiatal hernia), you may experience attacks of severe vomiting leading to throwing up stomach acid.

Symptoms of GERD:

An attack of GERD leading to persistent vomiting of yellowish stomach acid is often associated with a long history of recurrent GERD symptoms such as:

  • Heartburn: recurrent burning chest pain after eating (behind the breast bone).
  • Regurgitation: acidic fluid (stomach acid) or food into your throat or mouth.
  • Attacks of choking or cough during sleep.
  • Attacks of severe vomiting (often at night or in the early morning) lead to throwing up the acidic gastric juice if you are fasting or if the vomiting is frequent.
  • Nausea.
  • Anorexia.
  • Difficulty swallowing (not common).
  • Recurrent sore throat.
  • Bad mouth odor.
  • Recurrent cough, asthma, or chest infections.
  • Dental caries.

You have to consult your doctor if you get occasional attacks of persistent vomiting with GERD. It may be a sign of a hiatal hernia that is a correctable cause (via surgery). Hiatal hernia is diagnosed primarily by endoscopy.

Treatments:

An attack of GERD is treated as the treatment of gastritis (described above). A proton pump inhibitor and an anti-emetic are the mainstays of treatments.

Also, avoiding trigger foods (such as caffeine, acidic, fatty, and spicy foods) helps to stop the persistent vomit.

Head elevation during sleep improves the symptoms and decreases the morning or night vomiting with GERD.

Learn more.

4. Other possible causes of vomiting stomach acid:

The above three causes of vomiting stomach acid are the most common causes that often cause more than 90% of the cases of persistent vomiting.

Other less common causes of persistent vomiting of stomach acid include:

  • Pregnancy-related vomiting (especially Hyperemesis Gravidarum).
  • Medications include nonsteroidal anti-inflammatory medications (aspirin and ibuprofen), digoxin, antihypertensive, oral contraceptives, and others.
  • Cancer chemotherapy.
  • Alcohol abuse.
  • Migraine.
  • Radiation therapy.
  • Hypervitamonsis (as hypervitaminosis D).
  • Otitis Media.
  • Intestinal obstruction.
  • Irritable bowel syndrome.
  • Cholecystitis.
  • Hepatitis.
  • Chron’s disease.
  • Mesenteric ischemia.
  • Stomach or esophageal cancer.
  • Pancreatitis.
  • Brain diseases include brain hemorrhage, stroke, meningitis, tumors, etc.
  • Psychiatric diseases include psychogenic vomiting, anxiety, depression, and anorexia nervosa.
  • Extremely painful conditions (such as renal colics), etc.
  • Inner ear disorders such as motion sickness, labyrinthitis, tumors, etc.
  • Kidney failure.
  • Diabetic ketoacidosis.
  • Thyroid and parathyroid gland diseases such as hyperthyroidism and hyperparathyroidism.
  • Addison’s disease.
  • Cyclic vomiting syndrome.
  • Myocardial infarction and heart failure.
  • Starvation.
  • Post-operative.