Why Better Gut Health Care May Begin With More Precise Diagnostic Decisions

Gut health has become a mainstream conversation, but greater attention does not automatically make gastrointestinal symptoms easier to explain. Irritable bowel syndrome can involve abdominal pain, bloating, diarrhea, constipation, or a mixture of symptoms, and it is now understood as an organic disease. The American College of Gastroenterology's guideline supports a positive diagnostic strategy, alongside targeted testing where appropriate, rather than relying on an open-ended process of exclusion.

That distinction matters because treatment choices are more useful when clinicians have a clearer picture of what they are treating. The gut-brain relationship is complex and bidirectional, while the microbiome may also influence gastrointestinal function, as Cleveland Clinic explains. For patients, however, similar symptoms can still arise from different underlying mechanisms.

Ritesh Agarwal, CEO and Director of Gemelli Biotech, argues that this uncertainty is one reason gut health should move further toward diagnosis before intervention. Gemelli develops at-home diagnostics focused on gastrointestinal and gut-microbiome conditions. Agarwal explains, "Take the first step first, which is basically get diagnosed."

One area drawing attention is breath testing. Conventional testing has commonly focused on hydrogen and methane, while newer approaches developed by Gemelli BioTech, like Trio-Smart, can also measure hydrogen sulfide. Cedars-Sinai research has linked different gas-producing microbial patterns with IBS subtypes, reporting higher methane among participants with constipation-predominant IBS and elevated hydrogen and hydrogen sulfide among those with diarrhea-predominant IBS. Those findings do not turn a gas measurement into a stand-alone IBS diagnosis, but they suggest that additional biological signals may help clinicians characterize some patients more precisely.

For Agarwal, the importance of the third gas is also conceptual. If clinicians can learn something useful by measuring a signal that was previously absent from routine breath testing, he believes the field should remain open to what else may still be poorly understood. "Your gut microbiome has three main fermented gases in it. Legacy two breath tests measure hydrogen and methane, but we are able to capture and measure the third, hydrogen sulfide," he explains. "Previously some diarrheal patients may have been overlooked due to the lack of measurement of a third gas which is hydrogen sulfide." His larger point is that incomplete measurement can limit the clinical picture.

This is also where the discussion around supplements, probiotics, and elimination diets needs restraint. These options may have a role for some people, but they do not necessarily establish why symptoms are occurring. "Supplement doesn't mean that this is the core," Agarwal says. "It is an add-on to something. What is that something that needs to be figured out first?" In his view, treatment becomes more meaningful when it follows an informed assessment rather than a sequence of trial-and-error choices.

Recent evidence offers some support for examining diagnostic sequencing, although it should be interpreted carefully. A 2026 Frontiers in Gastroenterology study reviewed 219 adults with symptoms suggestive of IBS and found that patients who received IBS-Smart and/or Trio-Smart had lower captured diagnostic and office-visit costs and greater chart-level diagnostic persistence than controls. The study was observational, could not establish causality, and stated that the tests do not replace guideline-based clinical evaluation. Gemelli Biotech funded the study, while the authors reported that the company was not involved in study design, data collection, analysis, interpretation, writing, or the publication decision.

The wider lesson is not that every patient needs the same test. It is that better diagnostic decisions depend on matching the evaluation to the patient, the symptoms, and the clinical context. The ACG guideline, for example, recommends limited targeted testing in appropriate patients, including celiac serology and fecal calprotectin for certain people with diarrhea symptoms.

Agarwal believes progress will require clinicians, healthcare systems, researchers, and patients to move together. "It has to start with the healthcare, with the clinician, and then it has to come to the customer," he says. More education and research may help clarify where emerging tools fit, where uncertainty remains, and how clinicians can avoid treating symptoms in isolation.

Gut health is unlikely to become simple. The more practical goal is to make the path from symptoms to informed care clearer. As science identifies more measurable signals, the strongest approach may be one that combines better diagnostics with clinical judgment, appropriate rule-out testing, and continued research into what the gut can still teach us.