A Nutritional Approach to Minimal Hepatic Encephalopathy

Inclusion Criteria:

• All consented adults (age > 18), with the diagnosis of CHILD A cirrhosis with MELD score of < 10.
• Diagnosis of liver cirrhosis as documented by liver biopsy (stage IV) and / or fibroscan (score > 12 kpa) and / or fibrotest (score > 0.74) and /or imaging.

Exclusion Criteria:

• History of > grade II hepatic encephalopathy (HE).
• Diagnosis of dementia, Parkinson disease, Schizophrenia (Patients with major depression will be noted but not excluded).
• Use of sedatives, tranquilizers or anti- psychotic medication during and/or 2 weeks prior to enrolling Use of antibiotics for any length of period during and/or 2 weeks prior to enrolling.
• Current use of lactulose or neomycin.
• Use of alcohol or elicit drugs during and/ or 6 months prior to enrolling.