Background and study aim: Modification of intestinal flora, through different mechanisms is regarded as a therapeutic option in management of hepatic encephalopathy. We conducted this study to test the ability of probiotics in treatment of early grades of hepatic encephalopathy in Egypt. Patients and methods: One-hundred educated cirrhotic patients without overt hepatic encephalopathy were included. Diagnosis of cirrhosis based on clinical, ultrasonographic and laboratory findings and patients were screened for grade I and minimal hepatic encephalopathy by psychometric tests. Hepatic encephalopathy was diagnosed if at least one of psychometric tests was abnormal. Thirty patients with abnormal psychometric tests were included in the final analysis. Acidophilus capsules and banana were given to all patients 30 minutes before meals 3 times daily for 2 weeks. Results : Minimal and grade I hepatic encephalopathy were found in thirty out of the one hundred screened patients (30%). Minimal and grade I hepatic encephalopathy were more common in Child class C, than in class B and A. Two weeks after Lactobacillus acidophilus intake, patients showed significant improvement in the performance of psychometric tests (P<0.001) while liver function tests and Child classes did not improve (P>0.05). Probiotics improved the clinical grades of hepatic encephalopathy; 96.7% (n=29) of patients showed improvement in clinical grade of hepatic encephalopathy and only one patient (3.3%) did not improve (P<0.05). Conclusion : Probiotics could be used to treat early grades of hepatic encephalopathy. Child classes and liver functions did not improve significantly after probiotic therapy.