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I am a foreigner working at a company in Japan. My native language is English
but I believe I can converse somewhat moderately well in Japanese. After
dinner one evening, I heard the following exchange between two of my
coworkers, who are Japanese natives (this may be not the exact wording, but
this is the best I can recall):

A: 「うっ…なんか胃が痛い」  
B: 「え、腸じゃなくて？」  
A: 「うーん…分からない」  

On another occasion, I have also had the following exchange with a different
Japanese friend who does not work at the same company (again, the wording may
not be exact):

Me: 「さっき食べたらちょっと胃が痛くなってきた気がする…とりあえず胃薬飲んでみた」  
Friend: 「え？それ胃じゃなくて腸じゃないの？胃薬じゃなくて整腸薬飲めばよかったよ、それ」  

As someone who was raised in another country primarily speaking English, I can
not once recall ever thinking, "Gee, my intestines hurt." So my question is,
**under what circumstances would a Japanese person think specifically that
their intestines hurt as opposed to their stomach?** Or does 腸 include some
other part of the body in the abdomen where you would feel pain?

I suppose I could understand if the person were suffering from constipation or
diarrhoea for example, but I've never personally regarded either as a "pain in
my intestines", nor have I ever recalled experiencing any kind of sensation
that I could pinpoint as coming from my intestines, so the idea that "自分の腸が痛い"
seems unusually specific to me.

Is this some kind of cultural difference, or am I just weird, born without
feeling in my intestines or something?

**Edit:**

I realize now that I don't recall actually hearing the specific expression
"腸が痛い", so I believe my original premise may be flawed. As naruto's answer
suggested, both cases were most likely a case of informal "diagnosis", which I
admit seems obvious to me now in retrospect.
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question
usage
腸が痛い: How do you know when your intestines hurt?
胃が痛い is usually used but I think 腸が痛い isn't very common and we say おなかが痛い than
that.

If a person's intestines of health get worse like astriction and diarrhea, we
say usually "お腹の調子が悪い"
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2016-04-09T16:18:53.707
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answer
胃が痛い is common, and somewhat specifically used for so-called
[epigastric](https://en.wikipedia.org/wiki/Epigastrium) pain. お腹【なか】が痛い is
used for pain in any part of the abdominal region.

A person who has right lower
[quadrant](https://en.wikipedia.org/wiki/Quadrant_\(abdomen\)) pain (for
example, due to appendicitis) usually refers to a physician saying お腹が痛い,
腹痛がある, 下腹部痛がある, etc. At least in standard Japanese, 腸が痛い is not a common
phrase to describe symptoms even among those who have chronic bowel diseases.

However, sometimes people try to "diagnose" the cause of abdominal pain.
「それ胃じゃなくて腸じゃないの？」 in that context means "Isn't your pain caused by an
intestine trouble?", not "Aren't you feeling pain in your intestine?" For
example, one may say this if he is thinking of traveler's diarrhea. Or one may
say this when he knows the difference of symptoms of gastric ulcer and food
poisoning.
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answer