Efficacy and safety of non-pharmacological therapies for irritable bowel syndrome with diarrhoea: protocol for systematic review and network meta-analysis.

Irritable bowel syndrome with diarrhea (IBS-D) is a common digestive condition that can significantly impact daily life and well-being. While medications are available, many people seek natural treatment options. This study protocol outlines a comprehensive research plan to compare different non-drug therapies for IBS-D, including acupuncture, probiotics, cognitive-behavioral therapy, dietary changes, and fecal microbiota transplantation. The researchers will analyze published studies from multiple international databases to determine which treatments work best and are safest for reducing IBS-D symptoms like abdominal pain, bloating, and diarrhea. They'll also evaluate how these therapies affect quality of life and emotional well-being, as anxiety and depression often accompany IBS-D. This is not a completed study yet—it's a detailed plan (called a protocol) for how the research will be conducted. The team will use advanced statistical methods called network meta-analysis to rank all the treatments against each other, something that hasn't been done comprehensively before for IBS-D. This type of analysis is valuable because it allows researchers to compare treatments that may never have been tested against each other directly in clinical trials. Once completed, this research will help patients and healthcare providers make more informed decisions about which non-drug therapies are most likely to help with IBS-D symptoms. The results could influence future treatment guidelines and give patients evidence-based information about acupuncture and other natural approaches. If you're considering acupuncture for IBS-D, seek a licensed acupuncturist with experience treating digestive conditions.

This protocol describes a planned systematic review and network meta-analysis evaluating guideline-recommended non-pharmacological interventions for IBS-D, including acupuncture, probiotics, cognitive-behavioral therapy, dietary modifications, and fecal microbiota transplantation. The study will search eight databases from inception to January 2025 for randomized controlled trials in adults meeting Rome III or IV criteria. Primary outcome is the IBS Symptom Severity Score, with secondary outcomes including IBS Quality of Life Scale and Hospital Anxiety and Depression Scale. Two independent reviewers will assess studies using Cochrane Risk of Bias 2.0 tool. Network meta-analysis will employ frequentist methods via Stata and R software, with assessment of transitivity, heterogeneity, consistency, and publication bias. Evidence certainty will be graded using GRADE methodology with trial sequential analysis. This represents a comprehensive comparative effectiveness evaluation that will provide hierarchical ranking of non-pharmacological therapies, informing evidence-based clinical decision-making and potentially influencing future IBS-D treatment guidelines. No sample size or effect sizes are reported as this is a protocol for future analysis.