Why is My Stomach Hard at the Top? Gastroenterologist Explains.

Our content is not intended nor recommended as a substitute for medical advice by your doctor. Use for informational purposes only.

The sensation of a hard upper stomach is often related to your digestive system. Common causes of a hard sensation in the upper stomach include gassy foods, food intolerance, functional dyspepsia, gastritis, peptic ulcer diseases, and others.

Below, we will discuss the most common causes of the hard feeling in the upper stomach. This is not medical advice, contact your doctor if you have significant abdominal symptoms. 

 

1. Functional dyspepsia.

Functional dyspepsia is a prevalent functional digestive disorder. Functional dyspepsia is probably the commonest cause of hard upper stomach sensation. 

With functional dyspepsia, you will often have a sense of fullness or discomfort in the upper stomach area. This sense can progress to pain and burning sensation. 

Hard stomach feeling without evident epigastric pain is more suggestive for functional dyspepsia than gastritis and stomach ulcer.

Functional dyspepsia (also called idiopathic or non-ulcer dyspepsia) affects 5-11% of people worldwide (reference).

You can’t diagnose yourself with functional dyspepsia, as you need a doctor to exclude other diseases that mimic functional dyspepsia.

Your doctor will perform laboratory tests (as H. pylori testing) and endoscopy examination (esophagus, stomach, and duodenum). 

Functional Dyspepsia ROME IV Criteria.

1. One or more of the following:
a. Bothersome postprandial fullness
b. Bothersome early satiation
c. Bothersome epigastric pain
d. Bothersome epigastric burning
2. AND
No evidence of structural disease (including at upper endoscopy) that is likely to explain the symptoms
3. NOTES
* The above criteria must be fulfilled for the last three months
* symptom onset at least six months before diagnosis.

LEARN MORE ABOUT FUNCIONAL DYSPEPIA

 

2. Chronic gastritis and peptic ulcer disease.

 

Chronic gastritis occurs when your stomach lining becomes irritated or inflamed over time. Severe inflammation can destroy the lining and formation of the stomach or duodenal ulcer (peptic ulcer disease).

Chronic gastritis and peptic ulcer disease are classically present with burning or gnawing pain in the upper stomach (epigastric pain). 

However, many peptic ulcer diseases don’t have epigastric pain; instead, they are mild symptoms such as indigestion (ulcer dyspepsia) or discomfort (hard upper stomach). 

Chronic gastritis and peptic ulcer disease are commonly due to:

  • Infection (particularly H. pylori infection).
  • Irritation by certain foods (as spicy foods) or medication (such as Non-steroidal anti-inflammatory drugs).

Gastritis often causes frank pain in the upper stomach area (epigastric pain) rather than a sense of hard stomach.

Common Symptoms of gastritis and PUD:

  • Upper central stomach pain (most common site) sometimes feels like a hard stomach in the upper-middle abdomen.
  • The pain is usually dull, vague, burning, or aching pain.
  • Associated symptoms include:
    • Loss of appetite.
    • Nausea.
    • Vomiting (maybe blood if there is a stomach ulcer).
    • Bloating and abdominal discomfort.
    • Unexplained weight loss.
    • If bleeding ulcers, vomiting of blood (hematemesis), or passage of black stool (melena) can occur.

 

3. Food-related causes.

Food is probably the most common cause of bloating and distension. However, you don’t need to have a gut disease or food intolerance to get bloating from food.

Eating excess gas-producing foods can make you bloated and looking like you’re pregnant.

Also, some diseases that are related to food can make you bloated. The most common are food intolerances and allergies.

The main mechanisms of food-related bloating are:

  • Excess eating of gas-producing foods.
  • Food intolerances and allergies (such as lactose intolerance).
  • FODMAP intolerance (as in patients with IBS.

A. Excess eating of gas-producing foods.

Eating too many foods that are known to cause excess gas can make you bloated.

Gas-producing foods can lead to a hard stomach feeling due to excess gas inside your stomach.

Eating excess amounts of such food can cause bloating even in a healthy individual without any disease. In addition, the more you eat, the harder your stomach gets.

The list of food that commonly causes gas and bloating include (reference):

1. Milk and dairy products– milk,
– ice cream,
– and sometimes, cheese and yogurt.
2. Vegetables– Broccoli,
– cauliflower,
– Brussel sprouts,
– onions,
– leeks,
– parsnips,
– celery,
– radishes,
– asparagus,
– cabbage,
– kohlrabi,
– cucumber,
– potatoes,
– turnips,
– and rutabaga.
3. Fruits– Prunes,
– apricots,
– apples,
– pears,
– peaches,
– raisins,
– bananas
4. Whole grains-wheat,
– oats,
– bagels,
– wheat germ,
– pretzels,
– bran/bran cereal
5. Legumes– Beans,
– peas,
– baked beans,
– soybeans,
– lima beans
6. FatsFried and high-fat foods.
7. Drinks– Carbonated beverages,
– beer,
– carbonated medications
8. Others– chewing gum,
– artificial sweeteners

 

B. Food intolerances and allergies.

 

Food intolerance means you have trouble digesting or absorption certain types of food or food component.

As a result, the undigested and/or unabsorbed foods remain longer inside your intestines.

Bacteria then consume the stagnant food and produce extra gas (even with average amounts of food).

The more you eat from the offending foods, the more gas, burping, hard stomach you get.

Food intolerance is widespread, affecting up to 20% of people (reference).

Food intolerance is different from food allergy. Food allergy is defined as an allergic reaction to food (mediated by your immune system).

The differences between food intolerance and allergy are explained in the table below.

Food intoleranceFood allergy
Affects 15-20% of the populationAffects nearly 2-5% of adults
Difficulty digesting certain types of food (not immune-mediated allergy).An immune-mediated reaction to certain foods or food components.
Causes “recurrent acute” or “chronic” attacks of diarrhea and bloating.Usually causes acute attacks related to the ingestion of offending food.
Intestinal symptoms: diarrhea, extensive gas, bloating (hard stomach feeling), distension (looking pregnant), and abdominal painIntestinal symptoms are the same
No extraintestinal symptomsExtraintestinal symptoms like rashes, urticaria, swollen lips or face, or severe life-threatening allergic reactions.
The severity of your symptoms is proportional to the amount you eat from the offending food.Even trace amounts of the offending food can produce severe symptoms.

Common offending foods:

  • Lactose intolerance (dairy products).
  • Fructose malabsorption.
  • Alcohol intolerance.
  • FODMAP intolerance (as with People with IBS).

Common offending foods: (examples)

  • Raw meat, seafood.
  • Nuts, peanut
  • Mustard.
  • Rice
  • Some vegetables and fruits.

 

C. FODMAP intolerance.

 

FODMAPs are a group of foods that contain short-chain sugars that are rapidly fermentable. FODMAP is considered a type of food intolerance.

FODMAP is discussed separately here because it is linked to a prevalent disease called irritable bowel syndrome (IBS).

Eating FODMAPs can lead to excess bloating and distension. In addition, FODMAP intolerance produces symptoms of IBS, which include:

  • Recurrent abdominal pain (at least one day per week for several months.
  • Abdominal pain comes in periods of flare-ups and remissions.
  • Abdominal pain is
  • Change in bowel habits (diarrhea or constipation).
  • Changes in stool form (harder or looser stool).
  • IBS can be diarrhea-predominant, constipation-predominant, or mixed.
  • Bloating and distension. IBS is one of the most common causes of distension that can make you look pregnant.

Characteristics and sources of common FODMAPs are illustrated in the table below.

  Sugar typeFoods containing
FFermentable
OOligosaccharidesFructans, galactooligosaccharidesWheat, barley, rye, onion, leek, the white part of spring onion, garlic, shallots, artichokes, beetroot, fennel, peas, chicory, pistachio, cashews, legumes, lentils, and chickpeas
DDisaccharidesLactoseMilk, custard, ice cream, and yogurt
MMonosaccharides“Free fructose” (fructose in excess of glucose)Apples, pears, mangoes, cherries, watermelon, asparagus, sugar snap peas, honey, high-fructose corn syrup
AAnd
PPolyolsSorbitol, mannitol, maltitol, and xylitolApples, pears, apricots, cherries, nectarines, peaches, plums, watermelon, mushrooms, cauliflower, artificially sweetened chewing gum, and confectionery

You will notice similarities between the offending foods in food intolerance, gassy foods, and FODMAP foods.

We currently don’t fully understand the mechanism of IBS and food intolerance. However, These foods are evidenced to cause bloating and hard stomach feeling.

D. Excessive Air swelling:

  • Eating too fast.
  • Talking while eating.
  • Aerophagia (due to anxiety and psychological disturbances.).
  • Smoking.
  • Carbonated beverages.

 

4. IBS (irritable bowel syndrome).

 

According to research, up to  76% of IBS patients may suffer from bloating (reference).

Irritable bowel syndrome is a chronic functional gut disease that affects 15-20% worldwide.

IBS bloating is often generalized all over your abdomen, but it can be localized in the upper part cause hard stomach feeling.

Symptoms of IBS:

  • Recurrent abdominal pain (at least one day per week for the last 3 months).
  • The onset of pain is associated with defecation (bowel movements cause either improvement or worsening of pain).
  • Diarrhea and/or constipation during the IBS flare-up.
  • Bloating at any part of your abdomen (including the hard upper stomach area).
  • Mucus in the stool.

Learn how IBS is diagnosed HERE.

 

5. Gastroparesis (often due to long-lasting diabetes mellitus).

 

Gastroparesis is not a functional disease as functional dyspepsia. Instead, it is an actual motility disease of your stomach.

With Gastroparesis, your stomach is unable to contract and propel food properly. As a result, food stays longer inside your stomach, causing symptoms.

Causes of Gastroparesis include: (ref)

  • Unknown: about half of the cases of Gastroparesis has no apparent cause.
  • Diabetes Mellitus: diabetes destroys the nerves supplying your stomach, leading to Gastroparesis.
  • Some viral infections may induce gastropareses such as norovirus and rotavirus infection.
  • Some Medications: some anti-hypertensive drugs, tricyclic antidepressants, clonidine, GLP-1 agonists (a diabetes drug) can cause Gastroparesis.
  • Post-surgery: injury to the vagus nerve during abdominal or chest operations can lead to Gastroparesis.
  • Neurological diseases such as Multiple sclerosis. Multiple sclerosis causes a famous condition called “MS hug” or “MS band.” It is a feeling of a tight band around your chest or stomach.

Symptoms of Gastroparesis include:

  • Abdominal discomfort or pain: with a recurrent feeling of fullness and hard stomach. 
  • Nausea and vomiting are more common with Gastroparesis than functional dyspepsia.
  • Early satiety.
  • Bloating and fullness after meals.
  • Weight loss in severe cases.

Gastroparesis is suspected when nausea, bloating, and vomiting are frequent.

Your doctor may require a special test to diagnose Gastroparesis. The test is called “gastric emptying study.”

During this test, you ingest a meal with radioactive material. Then, a specialized camera detects how fast your stomach empties.

We wrote a detailed article about this test. Learn more HERE.

 

6. Constipation.

 

Functional constipation (also known as chronic idiopathic constipation) is a common disease that affects women more than men.

Its cause is unknown, No organic causes could be detected with functional constipation. However, it is thought to be a result of habitual withholding of feces in childhood (ref).

However, this is not the only theory; psychological factors and female hormones may also play a role.

With functional constipation, you may suffer from chronic constipation or hard stools but no remarkable abdominal pain (unlike IBS).

Bloating  (hard upper stomach feeling) is common with severe forms of functional constipation. So, if you are already a chronic constipation sufferer, bloating is probably a result.

Learn more about functional constipation HERE.

 

7. Medications.

 

Revise your list of medications, you can find the answer to bloating and distension in the medicines you take.

  • Aspirin.
  • Overuse of antacids.
  • Diarrhea medicines such as Immodium, Kaopectate, Lomotil, and others.
  • Opioid analgesics (causes constipation, bloating, and distension).

8. Less common causes:

 

  • Functional abdominal bloating.
  • Gallstone disease.
  • Acid reflux.
  • Stomach cancer.
  • Enlarged abdominal organs.
  • Other intra-abdominal tumors.
  • SIBO.
  • Stomach flu (viral Gastroenteritis).
  • IBD.
  • Others such as hypercalcemia, hyperkalemia, poor blood supply to the stomach or the intestines.

When to see a doctor for the hard upper stomach?

See a doctor if you have the following red-flag signs:

  • Weight loss without trying. 
  • The inability to complete your meal (bloating after eating very little).
  • Severe tenderness and hard upper abdomen or extreme abdominal pain.
  • Vomiting.
  • Blood in stool.
  • Steatorrhea (fatty diarrhea): recurrent yellowish oily diarrhea.
  • Abdominal pain that awakens you at night.
  • Unexplained fever.