Classic ALARM features to note in suspected IBS are:

1- Unintentional weight loss of more than 10 lbs

2- Iron deficiency anemia

3- Family history of IBD, colorectal cancer, or celiac sprue

4- Rectal bleeding or presence of occult blood in the stool

5- Nocturnal diarrhea

6- High volume diarrhea > 300 ml /day

7- Age 50 or more at the onset of IBS symptoms

Presence of ALARM SYMPTOMS in IBS has a positive predictive value of 30% for structural GI disease.