Your gut could be telling you a lot. Read on to learn how to decipher its clues.

THERE’S JUST ABOUT no worse feeling than a bad stomach-ache, especially when you have no clue what’s causing it.

While gut issues are inconvenient and downright miserable, they are extremely varied and associated with a wide variety of conditions, from food intolerance to cancer (and everything in between).

But if you’ve gone down the rabbit hole of “why does my stomach hurt” internet searches, you’ve probably seen the term “IBS” more than once. Irritable bowel syndrome (IBS) is a disorder that causes uncomfortable symptoms like bloating, constipation, diarrhoea, and mild abdominal pain. What makes IBS different from other conditions—and what you may have missed during frantic late-night internet excursions—is that these symptoms present themselves without any underlying damage to your digestive tract, so they’re not actually dangerous to your overall health.

Nevertheless, the cause of IBS remains somewhat of a scientific mystery. According to the National Institute of Diabetes and Digestive and Kidney Disorders, IBS may have something to do with a connection problem between your brain and gut, causing sensitivity in your digestive system. Other experts link the condition to family history and stressful life events.

Lisa Ganjhu, D.O., a gastroenterologist at NYU Langone Health in New York City, describes the different things that can trigger the onset of IBS: food sensitivities, changes in your gut microbiome, underlying inflammation, or the inability for food to move through your GI tract easily. Plus, IBS is “often mistaken for other disorders,” according to Dr. Ganjhu. Testing is the only true way to know for sure what type of condition you’re dealing with. Talk to your doctor to learn more, and in the meantime, here’s a breakdown of other GI disorders that can masquerade as IBS.

Conditions Mistaken for IBS
Celiac Disease
Jesse P. Houghton, M.D., Senior Medical Director of Gastroenterology at Southern Ohio Medical Centre in Portsmouth, Ohio, says he typically tries to rule out celiac disease before diagnosing a patient with IBS. “Celiac disease is a hereditary condition where the affected patient cannot tolerate gluten, a protein in wheat and barley,” he explains. “Just as with IBS, celiac patients can get bloating, diarrhoea, and abdominal cramping (when they eat foods containing gluten).”

How it’s diagnosed and treated: Dr. Houghton uses either a blood test or an endoscopy – a procedure that allows a doctor to look inside your GI tract and small intestine. The only available treatment for celiac disease is a gluten-free diet.

Other Food Intolerances
Dr. Ganjhu explains that other dietary sensitivities can also cause similar symptoms. If you notice your symptoms are consistently tied to a particular kind of food, consider working with a doctor or dietician to try an elimination diet. This can help you figure out exactly what ingredients are bothering you. Unlike a food allergy, which causes an immune reaction in the body and can be life-threatening, a food intolerance simply means that your body doesn’t tolerate the food well—meaning it makes you feel bloated and uncomfortable as you digest it. Food allergies can also cause a hurt stomach, but the reaction will likely be more severe, such as vomiting or diarrhoea.

How it’s diagnosed and treated: Your healthcare provider can use a series of blood tests or skin prick tests to determine whether you have an allergy. To figure out your food intolerances, you may want to try an elimination diet, where you specifically limit and reintroduce specific foods to see how you react. Once you figure out your intolerances, your best bet for treatment is to avoid eating those foods.

Fibromyalgia
Dr. Ganjhu also lists fibromyalgia as a potential GI irritant. This condition affects 4% of the U.S. adult population, and it causes pain, fatigue, and stiffness all over the body. It can also cause digestive problems such as abdominal pain, bloating, and constipation. Fibromyalgia is most commonly diagnosed in people middle aged or older, and those with rheumatoid arthritis or lupus are at increased risk for developing it.

How it’s diagnosed and treated: Fibromyalgia is diagnosed using x-rays, blood work, a physical examination, and a medical history analysis. It is treated by an arthritis specialist with a combination of medications and lifestyle changes.

Inflammatory Bowel Disease (IBD)
Though they have similar names, IBS and IBD are not the same thing. Inflammatory bowel disease, the umbrella term for Crohn’s and ulcerative colitis, is a long-term chronic condition that causes damage to your intestinal walls. If your gut symptoms are debilitating and consistent, and they make it difficult to live your life normally, you may want to consider testing for IBD.

How it’s diagnosed and treated: The diagnostic process for IBD involves an assessment of symptoms, blood tests, diagnostic imaging (such as CT scans and x-rays), and, if necessary, an endoscopic procedure. It is treatable with medication, lifestyle changes, and surgery, but it will likely require significant work with a gastrointestinal professional.

Helicobacter Pylori (H. pylori)
This sounds like some combination between a helicopter and a dinosaur, but it’s actually a type of bacteria that can live in the human stomach. “Although our stomach acid kills the vast majority of bacteria we ingest, the bacteria has adapted over time to be able to bury itself in the mucosal barrier lining our stomach, thus evading the acid,” Dr. Houghton explains. “This bacteria commonly causes nausea, abdominal pain, and cramping, but can also cause diarrhoea (again, same as IBS).” If left untreated, it can cause stomach ulcers and increase your risk of cancer.

How it’s diagnosed and treated: The bacteria can be identified through a breath test, stool sample, or blood test. Dr. Houghton says, “Treatment is a combination of two antibiotics, along with a PPI (proton pump inhibitor) twice a day for 10-14 days.” After that, your symptoms should subside.

Anxiety and/or Depression
Although you might not expect it, psychological stress can play a role in how your digestive system functions, according to Dr. Ganjhu. The walls of your digestive tract contain more than 100 million nerve endings, called the enteric nervous system (ENS). These nerves communicate with your brain, and researchers believe that there is a link between your mood and the way your digestive system functions. Dr. Ganjhu explains that PTSD, another psychological condition, can also trigger gut issues.

How it’s diagnosed and treated: If you’re feeling especially anxious or sad lately, make an appointment to see a licensed therapist or psychiatrist who can diagnose you. Mental health treatments like antidepressants and cognitive behavioural therapy may help.

Conditions That Sometimes Combine With IBS
IBS isn’t always a standalone condition—it often goes hand-in-hand with other health issues. If you’ve been diagnosed with one of the following conditions, but you’re also having gastrointestinal symptoms consistent with IBS, you could have both things at once.

Chronic Fatigue Syndrome (CFS)
This long-term chronic condition, officially named myalgic encephalomyelitis, affects up to 2.5 million Americans, but it often goes undiagnosed. According to a 2017 Columbia University study in Microbiome, CFS is tied to abnormal levels of certain gut bacteria, and up to 90% of patients with CFS also have symptoms consistent with IBS. Dr. Ganjhu confirms that CFS could be missed when diagnosing patients with IBS, or vice versa.

Migraines and Tension Headaches
A 2016 study in Neurology found genetic similarities between headache disorders and GI conditions such as IBS. While more research still needs to be done on this subject to confirm the specifics, Dr. Ganjhu agrees there is a notable connection.

Temporomandibular Joint Disorder (TMJ)
This surprisingly common disorder affects more than 10 million Americans. It is characterized by muscle pain in the jaw, and Dr. Ganjhu notes that it is connected with IBS. If you have TMJ and you also experience IBS symptoms, you could have some combination of both and not realize it.

Other Uncommon Conditions
The possibilities don’t end here. Dr. Ganjhu cites multiple other conditions that have been shown to be connected to IBS symptoms, including chronic pelvic pain, interstitial cystitis, non-cardiac chest pain, and chemical insensitivities.

It’s a long list, and your best bet for diagnosis is to share your symptoms with a medical professional, says Dr. Ganjhu. Once diagnosed, you can better understand your “triggers,” including the foods you may be allergic to, the way your body responds to stress, or any co-conditions that exacerbate your gut problems. Then, Dr. Ganjhu asserts, you can begin to find a way back to normal, without your symptoms getting in the way.

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