Vomiting bile: when is it serious?

Bilious vomiting means that a person’s vomit is yellow-green, which is the color of bile. The liver produces bile, a digestive fluid. Bilious vomiting may mean that a person has a blockage somewhere in their gastrointestinal tract. They can also occur when a person vomits on an empty stomach. Also, they often occur in infants born with intestinal obstruction. Parents and caregivers who notice bile-colored vomiting 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 that ?

Bilious vomiting means that a person’s vomit is the color of bile. This is usually green, yellow or a mixture of both. It often has a very bitter taste. In general, bilious vomiting is benign, that is to say harmless. They often occur when a person vomits on an empty stomach. However, in infants they can be a cause for concern. Bilious vomiting in infants may be a sign of a malformation of the gastrointestinal tract.

Causes of bilious vomiting

Bilious vomiting usually occurs when something prevents bile from passing through the digestive tract normally. This usually signals some type 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. Infants are born with this condition.

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

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

– 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 affecting the ability of the large intestine to move stool
– pregnancy, in particular hyperemesis gravidarum, which can cause intense vomiting likely to endanger pregnancy and the pregnant person.

Risk factors

Anyone can vomit bile. Circumstances that increase the risk are:

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

Bilious and non-bilious vomiting

Vomiting is relatively common and most people suffer from it at one time or another. Most vomiting is non-bilious, which means 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. However, non-bilious vomiting may 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 which 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 in which bilious vomiting occurs. He can :

– ask about a recent illness or ask for a pregnancy test
– ask if the person vomited on an empty stomach
– perform an examination to check for other symptoms, such as upper abdominal tenderness
– ask for tests to look 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 infants, 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 be unable 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.


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

* Presse Santé strives to transmit health knowledge in a language accessible to all. In NO CASE, the information given can not replace the advice of a health professional.

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