Comparative effectiveness and underlying mechanisms of acupuncture approaches in IBS-D animal models: a protocol for systematic review and network meta-analysis.

Irritable bowel syndrome with predominant diarrhea (IBS-D) is a type of functional gastrointestinal disorder mainly marked by abdominal discomfort and frequent loose stools. Its complex pathogenesis involves multiple factors, such as low-grade intestinal inflammation, brain-gut axis dysregulation, and visceral hypersensitivity. Although acupuncture therapies show the potential to alleviate IBS-D symptoms, systematic evidence regarding their comparative efficacy and underlying mechanisms remains lacking. Methods A systematic search will be conducted across eight major databases: CNKI, WanFang Data, VIP, CBM disc, PubMed, Embase, Web of Science, and CENTRAL. This search will aim to comprehensively collect randomized controlled animal studies on acupuncture therapies for IBS-D. Two independent researchers will extract and record basic study information, characteristics of experimental animals, intervention details, and outcome measures. The primary outcome to be evaluated will be the minimal volume threshold for the abdominal withdrawal reflex (AWR). Secondary outcome measures will include the loose stool rate and levels of biomarkers such as IL-1β, TNF-α, SP, and 5-HT. Data collected will be analyzed utilizing R 4.4.1 and Stata 17.0 software for frequentist network meta-analysis to compare the efficacy of various acupuncture treatment options in IBS-D animal models. Standardized mean differences (SMD) with 95% confidence intervals (CI) will be calculated as the primary effect measure. Treatment rankings will be generated using P-scores, the frequentist analogue of SUCRA. Additional analyses, such as subgroup analysis, sensitivity testing, and meta-regression will be performed. Risk of bias will be evaluated through the SYRCLE risk of bias tool. This study represents the first network meta-analysis integrating indirect and direct evidence from various acupuncture therapies in IBS-D animal models. It aims to provide high-level evidence for optimizing acupuncture therapy selection and clarifying its mechanisms. The network meta-analysis will generate robust preclinical evidence to identify the most effective acupuncture modalities for IBS-D and reveal their underlying mechanisms. The findings will guide future clinical trial design by informing the choice of optimal acupuncture strategies and relevant biological endpoints, thereby promoting the translation of preclinical evidence into clinical practice. Ethics and dissemination Since this is a systematic review and meta-analysis, ethical approval is not deemed necessary. INPLASY registration number INPLASY202470113.