Effects of electroacupuncture on neurological outcomes and brain-gut axis-associated changes in experimental ischemic stroke models: a systematic review and meta-analysis.

BACKGROUND: Ischemic stroke is a leading cause of death and disability worldwide and is frequently accompanied by brain-gut axis disturbances, including intestinal barrier dysfunction, gut microbiota dysbiosis, and immune-inflammatory imbalance. Although electroacupuncture (EA) has demonstrated neuroprotective effects in experimental stroke, its effects on brain-gut axis-related outcomes have not been systematically evaluated. OBJECTIVE: To evaluate the effects of EA on neurological outcomes and brain-gut axis-related changes in animal models of ischemic stroke. METHODS: This systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 statement and registered in PROSPERO (CRD420261354722). Nine databases were searched from inception to 1 May 2026. Controlled animal studies comparing EA with non-EA controls in ischemic stroke models were included. Random-effects meta-analyses were performed using Hedges' g standardized mean differences (SMDs) with 95% confidence intervals (CIs). Risk of bias was assessed using the SYRCLE tool, and the certainty of evidence was evaluated using an adapted GRADE framework for preclinical animal studies. RESULTS: Thirteen reports representing 12 independent studies were included. EA was associated with improved neurological function (11 studies; SMD = -2.49, 95% CI: -3.50 to -1.47; I 2 = 60.5%) and reduced infarct volume (9 studies; SMD = -3.08, 95% CI: -4.22 to -1.95; I 2 = 56.2%). EA was also associated with increased ZO-1, occludin, and intestinal IL-10 levels and reduced D-lactate, lipopolysaccharide, intestinal IL-1β, and intestinal TNF-α levels. Qualitative synthesis suggested EA-associated changes in gut microbial diversity and taxonomic composition, although their functional significance remains uncertain. The certainty of evidence ranged from moderate to very low, and several brain-gut axis-related outcomes were supported by only a small number of studies. CONCLUSION: EA-related neuroprotection in ischemic stroke may be partially associated with modulation of brain-gut axis-related processes; however, the available evidence does not establish these processes as the primary mediator. Further rigorously designed preclinical studies are needed to strengthen causal inference and facilitate clinical translation. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261354722, Identifier: CRD420261354722.