6 Causes of Throwing Up Bile After Drinking Water.
Our content is not intended nor recommended as a substitute for medical advice by your doctor. Use for informational purposes only.
Bile is a yellowish-green fluid produced by your liver and secreted into the duodenum (the upper part of the small intestine just below the stomach).
Under normal conditions, bile passes through the intestine and doesn’t flow upwards to the stomach.
In some conditions, you may vomit greenish or yellowish bile-stained fluid (even after drinking water).
The most common causes include:
- A severe attack of acute gastroenteritis (especially stomach flu or viral gastroenteritis).
- Food poisoning (foodborne illness).
- Intestinal blockage (particularly the upper part of the small intestine).
- Binge drinking alcohol.
- Cyclic vomiting syndrome.
- Biliary reflux gastritis.
- Gastritis or peptic ulcer disease.
- An attack of GERD.
- False bile vomiting (as with vomiting yellow drinks, stomach acid, or yellow mucus).
1. Acute gastroenteritis.
Acute gastroenteritis is an infection (commonly caused by stomach viruses) to the stomach, the intestine, or both (reference).
Gastroenteritis is caused by:
- Viruses: Norovirus (commonest), rotavirus, adenovirus, and others.
- Bacteria:L Campylobacter, E. coli, salmonella, shigella, etc.
- Parasitic: Giardia lamblia, entamoeba histolytica, and cryptosporidium.
The most common and the most likely cause of vomiting bile after drinking anything (including water) is viral gastroenteritis (stomach flu).
Consider acute gastroenteritis, abdominal pain, and diarrhea if you have an acute onset of throwing up bile after drinking water.
Throwing up and/or diarrhea can cause significant complications in the elderly and infants.
Symptoms of viral Gastroenteritis:
- Acute onset extreme nausea and throwing up.
- In the first few attacks, the vomiting may contain food particles; as the throwing up continues, you may vomit bile after drinking or eating anything (including water).
- Attacks of intense abdominal colic (in the upper, lower abdomen, or all over your stomach).
- Diarrhea may present with or after the attacks of throwing up bile.
- Low-grade fever and mild chills may also occur.
- Muscle aches.
- Loss of appetite (anorexia).
- Viral gastroenteritis with throwing up is often a self-limiting illness that typically lasts a day or two.
2. Food poisoning (foodborne illness).
Food poisoning or foodborne illness is a term that describes illness (such as throwing up and diarrhea) caused by microbes or toxins found in food or drinks.
Food poisoning is also a common cause of persistent acute vomiting (throwing up bile after drinking water or anything).
The vomiting from food poisoning is often more severe than classical gastroenteritis.
Causes of food poisoning:
Food poisoning is caused by ingesting foods or drinks contaminated with the following organisms or their toxins.
The possible organisms that may cause food poisoning are illustrated in the table below according to their food source (reference).
|Type of food||Possible cause|
|Raw seafood||Norwalk-like virus, Vibrio spp, hepatitis A|
|Raw eggs||Salmonella spp|
|Undercooked meat or poultry||Salmonella spp, Campylobacter spp, STEC, Clostridium perfringens|
|Unpasteurized milk or juice||Salmonella spp, Campylobacter spp, STEC, Yersinia enterocolitica|
|Unpasteurized soft cheeses||Salmonella spp, Campylobacter spp, STEC, Y. enterocolitis, Listeria monocytogenes|
|Homemade canned goods||Clostridium botulinum|
|Raw hot dogs, deli meat||L. monocytogenes|
Symptoms of food poisoning:
Viral gastroenteritis is a mild, self-limiting, & short-term illness (reference. On the other hand, food poisoning is often a more severe illness with a higher chance of severe vomiting.
Patients throwing up due to food poisoning often experience frequent vomiting attacks. At first, the vomiting may contain food particles or clear fluid. As the attack continues, throwing up bile after drinking or eating anything is common.
The table below illustrates some basic differences between stomach flu (viral gastroenteritis) and bacterial food poisoning.
|Stomach Flu||Food Poisoning|
|Caused by viruses||Caused by bacteria, viruses, parasites, toxins, or chemicals.|
|Food is not the only source of infection; stomach flu can be acquired by unwashed hands or dirty surfaces, droplet infection, or direct contact with an infected person.||Infection is due to eating or drinking contaminated food/drinks.|
|Symptoms start after a day or more of infection.||Symptoms start shortly after eating contaminated food (usually 2-6 hours)|
|Complications are rare||The complications are common, such as severe vomiting, diarrhea, dehydration, or even dangerous complications like botulism.|
|Diarrhea is usually brownish or yellowish.||Diarrhea is more severe, watery, and can be yellow, greenish, and bloody.|
3. Gastritis & peptic ulcer disease.
Gastritis (stomach inflammation) and peptic ulcer disease (ulcers in the stomach or duodenum) are two very common diseases that may cause vomiting and nausea.
Faulty eating habits (as with fatty foods, alcohol, caffeine, and spicy foods), Nonsteroidal anti-inflammatory drugs, and H. Pylori infections are the most common causes of gastritis and PUD.
Patients with gastritis and peptic ulcer disease typically experience recurrent epigastric (upper stomach) pain.
In addition, gastritis and ulcers may present with severe attacks of nausea and vomiting (even after drinking water). This is particularly common among non-compliant people on
Symptoms suggestive of gastritis or peptic ulcer disease (reference):
- 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).
4. Bile reflux gastritis.
Bile is a digestive liquid produced by your liver and passes into the duodenum (the first part of the small intestine).
Biliary reflux gastritis occurs when bile backs up (refluxes) into your stomach from the duodenum (reference).
The presence of bile in the stomach irritates its lining and may cause bile vomiting.
Undiagnosed bile reflux is one of the major causes of nonresponse to gastritis and acid reflux medications.
One study estimated that 68.7% of people who don’t respond to stomach acid medications (such as omeprazole) have bile reflux.
Bile reflux gastritis may cause extreme stomach irritation and persistent vomiting of yellow bile even after drinking plain water.
The most common causes & risk factors include (reference):
- Previous stomach operations (as bariatric surgery).
- Previous biliary operations such as cholecystectomy.
- Previous ERCP.
- Liver diseases such as liver cirrhosis.
- Prolonged fasting (bile reflux normally occurs when you fast for long hours) (reference).
The symptoms are essentially the same as gastritis (explained below), but the patient doesn’t respond to anti-acid medications.
- Epigastric (upper stomach) pain or heartburn in the chest doesn’t respond to acid medications such as omeprazole or esomeprazole.
- Persistent or recurrent nausea.
- Vomiting attacks (it can be severe and persistent even after eating anything, including water).
- The vomit may contain yellow bile, especially if the attacks are frequent or prolonged fasting.
- Bloating and indigestion.
- A band of tightness under breasts.
4. Gastric outlet & Intestinal obstruction (Upper small intestinal obstruction).
Obstructing the gastrointestinal tract just under the stomach may cause persistent throwing up even after drinking water.
However, obstruction of the lower part of your gut tract (the colon) doesn’t present with vomiting until the late stage (often, the vomit contains fecal material).
The two main conditions that may cause persistent vomiting to include:
- Gastric outlet obstruction (by a tumor, fibrosis, or polyp): occurs in the pyloric sphincter (a sphincter between the stomach and the first part of the duodenum. Causes include:
- Pyloric tumors (tumors in the last part of the stomach).
- Pyloric stomach ulcers.
- Pyloric gastritis (as with H. pylori infection).
- Pyloric polyp
- Upper small intestinal obstruction: obstruction in the duodenum, the jejunum (part of the small intestine) may present persistent throwing up even after drinking water. Causes:
- Tumors obstruct the duodenum or the small intestine.
- Stricture (narrowing).
- Intestinal adhesions (often due to multiple intraabdominal operations).
A. Gastric outlet obstruction:
- Epigastric (upper stomach) pain.
- Early satiety.
- Persistent or recurrent nausea.
- Recurrent or persistent throwing up (in acute or complete obstruction, patients may vomit everything, even water).
- Severe upper stomach bloating and distension.
- Chronic cases may cause weight loss.
B. Upper small intestinal obstruction:
- Persistent vomiting.
- Cramping abdominal pain
- Inability to pass flatus or stool (absolute constipation).
- Bloating and distension.
5. False bile vomiting
Vomiting a yellow or bitter liquid doesn’t always mean bile. Yellow liquid can be a result of:
- Yellow drinks (or foods).
- Throwing up gastric juice (mainly stomach acid).
A. yellow foods or drinks.
Vomiting yellow fluids can be a result of yellow drinks or foods such as:
- Mango juice.
- Orange juice.
- Pineapple juice.
- Tropical cocktails.
- Fanta or Mirinda (Yellow-colored soft drinks).
- Yellowish alcoholic drinks such as Gin and apricot
So, vomiting a yellow liquid doesn’t have to be bile. Always check if you’ve taken any yellow drink before vomiting.
B. Throwing up stomach acid (stomach juice).
Stomach juice contains stomach acid (HCL), digestive enzymes, and mucus. People who are fasting vomit stomach juice (stomach acid) which is a yellowish, bitter fluid.
Moreover, bile refluxes back to the stomach of healthy people who fast for several hours. So, the vomit may be a mixture of acidic stomach juice and alkaline bile.
6. Other Causes of persistent vomiting.
- Binge alcohol drinking.
- Medications: The most common medications that may cause vomiting of yellow liquid are chemotherapy, nonsteroidal anti-inflammatory drugs, antibiotics, chemotherapy, digoxin, and some antihypertensive medications.
- Cyclic vomiting syndrome.
- Gallbladder Conditions such as gallstones, acute cholecystitis, and functional gallbladder diseases.
- Female hormonal disturbances: Before and during the period (premenstrual syndrome), ovarian cysts, polycystic ovary syndrome, ectopic pregnancy, endometriosis, etc.
- Psychological conditions: As with extreme stress, anxiety, depression, fear, and eating disorders such as Anorexia Nervosa and Bulemia Nervosa.
- Pancreatitis (acute and chronic).
- Gastric outlet obstruction.
- Intra-abdominal tumors (such as stomach and pancreatic cancer).
- Diabetic gastroparesis (lazy stomach): Often causes vomiting of large volume of food and fluid. it rarely causes persistent vomiting of bile.
- Diabetic ketoacidosis.
- Kidney stones (severe pain from the stone may lead to persistent vomiting on an empty stomach).
- Acute renal failure
- Intestinal obstruction
- Acute hepatitis
- Extremely painful conditions
- Endocrinal diseases such as hyperparathyroidism, hyperthyroidism, and Addison’s disease.
- Acute intermittent porphyria
- Post-operative abdominal pain and vomiting
- Heart attack (acute coronary syndrome)
- Familial Mediterranean fever
- Hypervitaminosis (excess vitamin supplementation).