Summary Liver cirrhosis is a chronic condition of the liver and is the 14th most common cause of death around the world; yet it remains an incurable disease. Probiotics have gained significant popularity as a potential treatment option for liver cirrhosis.

Methods A systematic review and meta-analysis was conducted to assess the effects of probiotics on liver cirrhosis. PubMed, Scopus, Cochrane Central Register for Controlled Trials (CENTRAL) and ProQuest Dissertation and Thesis were searched from 2000 to January 2024 for studies that evaluated the effects of probiotics on a variety of outcomes of liver disease.

Results A total of 22 randomised controlled trial studies were included in the meta-analysis. Probiotics significantly decreased Gamma-glutamyl transferase (effect size: -0.307, p=0.024, 95% CI [-0.572, -0.040]) and Aspartate aminotransferase (p=0.013, 95% CI [-17.927, -2.128]). Significant reduction in serum ammonia levels (effect size= -1.093, p= 0.000, 95% CI [-1.764, -0.423]) and endotoxin levels (effect size= -0.961, p=0.000, 95% CI [-1.537, -0.385]) were also found.

Summary Overall probiotics could be recommended as a potential adjunct therapy for patients with cirrhosis, as they appear to have some benefit in improving liver function, and are well tolerated with minimal adverse effects. More comprehensive research with larger sample sizes is recommended to understand more about the widespread effects of probiotic use.