Introduction Irritable bowel syndrome with diarrhoea (IBS-D) significantly impairs patients’ quality of life. Although various non-pharmacological interventions show promise, evidence on their comparative effectiveness remains limited. This protocol outlines a systematic review and network meta-analysis designed to comprehensively evaluate and rank the efficacy and safety of guideline-recommended non-pharmacological therapies. Methods and analysis We will systematically search PubMed, Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure, Chinese Biomedical Database, Wanfang Data and VIP Database from inception to January 2025. Eligible studies will include randomised controlled trials assessing guideline-recommended non-pharmacological interventions, probiotics, acupuncture, cognitive–behavioural therapy, dietary modifications and faecal microbiota transplantation in adults diagnosed with IBS-D based on Rome III or IV criteria. The primary outcome is the Irritable Bowel Syndrome Symptom Severity Score. Secondary outcomes include the Irritable Bowel Syndrome Quality of Life Scale and Hospital Anxiety and Depression Scale. Two independent reviewers will screen studies, extract data and evaluate risk of bias using the Cochrane Risk of Bias 2.0 tool. Network meta-analysis will be performed using frequentist methods with Stata and R software. Transitivity, heterogeneity, consistency and publication bias will be assessed. Certainty of evidence will be graded using the Grading of Recommendations, Assessment, Development and Evaluations methodology, supplemented with trial sequential analysis to determine the required information size. Ethics and dissemination Ethical approval is not required for this secondary analysis as it uses published data. The results will be disseminated via peer-reviewed journals and conference presentations to inform clinical practice and guideline development. Registration INPLASY202470112.
Liu et al. (Thu,) studied this question.