A meta-analysis compared the efficacy and safety of probiotics versus lactulose in the treatment of minimal hepatic encephalopathy (MHE) in patients with liver cirrhosis. It included five randomized controlled trials with a total of 345 patients. No statistically significant differences were found in reversing MHE (RR: 0.98, 95% CI: 0.79–1.20; p = 0.822), preventing the development of overt hepatic encephalopathy (RR: 1.40, 95% CI: 0.75–2.289), or reducing serum ammonia (MD: -0.05, 95% CI: -0.29 to 0.19; p = 0.678). However, probiotics showed a significantly lower incidence of adverse events compared to lactulose (RR: 0.17, 95% CI: 0.05–0.60; p = 0.005). The studies searched databases such as PubMed, Cochrane Library, Embase, Web of Science and the Chinese Biomedical Database until August 2025. The authors emphasize the need for further large randomized controlled trials to confirm the findings.