Vomiting bile: when is it serious?

Bile vomiting means that a person’s vomit is yellow-green, which is the color of bile. The liver produces bile, a digestive fluid. Bile vomiting can mean that a person has a blockage somewhere in their digestive tract. They can also occur when a person vomits on an empty stomach. They also often occur in babies born with intestinal obstruction. Parents and caregivers who notice bile-colored vomit in a baby, especially during the first two days of life, should seek urgent medical attention. Read on to learn more about bilious vomiting, its causes, risk factors, and more.

What is it ?

Bile vomiting means that a person’s vomit is the color of bile. It is usually green, yellow or a mixture of both. It often has a very bitter taste. Generally, bilious vomiting is benign, that is, harmless. They often occur when a person vomits on an empty stomach. In babies, however, this may be a cause for concern. Bile vomiting in babies can be a sign of a malformation of the digestive tract.

Causes of bile vomiting

Bile vomiting usually occurs when something prevents bile from moving normally through the digestive tract. This usually indicates some kind of obstruction. One of the most common causes in newborns and young children is duodenal atresia, a condition in which the small intestine does not develop properly. Babies are born with this condition.

It causes vomiting, often of bile, during the first day or two of life. This usually happens after the first feeding.

Other factors can cause bilious vomiting in children and adults. These include the following factors:

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– vomiting on an empty stomach
– a gallstone in the common bile duct
– other congenital obstructions, such as a duodenal diaphragm
– intestinal obstruction
– Hirschsprung’s disease, a congenital bowel disorder that affects the ability of the large intestine to move stool
– pregnancy, especially hyperemesis gravidarum, which can cause intense vomiting which is likely to endanger pregnancy and the pregnant person.

Risk factors

Anyone can vomit bile. Circumstances that increase the risk:

– the pregnancy
– being a newborn baby or baby
– recent illness causing intense vomiting
– liver or gallbladder disease
– Presence of other congenital disorders from the reliable source, such as Down syndrome.

Bile and non-bile vomiting

Vomiting is relatively common and most people suffer from it at one time or another. Most vomit is non-bilious, meaning that the vomit is not the color of bile.

The causes of non-bilious vomiting are:

– the pregnancy
– infections, such as food poisoning
– appendicitis
– exposure to drugs or toxins

Non-bilious vomit is usually neither green nor yellow. But non-bilious vomiting can look like bilious vomiting. A person’s vomit can be different colors depending on the food they eat, how often they vomit, how much water they drink and other factors.


In an infant or newborn, doctors usually assume that bilious vomiting is caused by an obstruction somewhere in the intestinal tract. For this reason, they will likely treat bilious vomiting as an emergency. They will order imaging tests that may include an X-ray or contrast imaging, which involves injecting a dye into the body and then performing a CT scan.

In adults, doctors will assess the general context within which bilious vomiting occurs. He can:

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– ask about a recent illness or ask for a pregnancy test
– ask if the person vomited on an empty stomach
– do an examination to check for other symptoms, such as abdominal tenderness
– ask for tests to check for gallstones or an obstruction.


Treatment depends on the likely cause of a person’s vomiting. When there is no obvious cause, the doctor may recommend waiting to see if the person’s condition improves. However, in babies, the condition will be treated urgently. If doctors determine the cause is a blockage, such as duodenal atresia, surgery can treat the condition. Without surgery, the baby may not be able to absorb nutrients, so the doctor may recommend surgery right away.

Here are other possible treatments:

– anti-nausea drugs to stop vomiting
– treatment of an underlying infection
– surgery to remove an obstruction
– removal of the gallbladder if a person has gallstones
– administration of intravenous (IV) fluids to prevent dehydration.


The outlook depends on the cause of the bilious vomiting. In most cases, the outlook is good with proper treatment. Many people may not need any treatment. For example, a person may vomit bile if they are pregnant and have morning sickness on an empty stomach or if they vomit on an empty stomach during a stomach virus.

However, there is a risk of dehydration in case of severe vomiting. A condition called hyperemesis gravidarum, which is a severe type of morning sickness, can cause this. In this case, the person may need anti-nausea medication or intravenous fluids.

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Vomiting bile can be alarming, especially if the person does not know the reason for the vomiting. However, they can be treated, and in adults they can go away on their own. Parents and caregivers should treat bilious vomiting in newborns and very young infants as a medical emergency requiring immediate care, especially if the vomiting occurs after the infant’s first meal. A doctor can determine the cause of the vomiting and treat it accordingly.

* Presse Santé strives to convey health knowledge in a language accessible to all. In NO CASE, the information given can replace the advice of a healthcare professional.

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