Study of Rifaximin in Minimal Hepatic Encephalopathy

Effect of Rifaximin Therapy on Brain Activation in Patients With Minimal Hepatic Encephalopathy Using Functional MR, MR Spectroscopy,Diffusion Tensor Imaging Microbiome and Metabolome: a Prospective Trial

Rifaximin therapy will improve brain functioning on MRI scanning and change the microbiome and metabolome.

Inclusion Criteria:

• Age 18-65 years
• cirrhosis diagnosed by clinical or biopsy grounds
• Minimal hepatic encephalopathy defined by impaired performance on at least 2 of the following: number connection tests A/B, digit symbol and block design tests (NCT-A, NCT-B, DST and BDT) compared to age and education-matched controls.
• No contraindications to MRI
• TIPS (transjugular intra-hepatic porto-systemic shunt) procedure or elective surgery planned within the next 8 weeks

Exclusion Criteria:

• Current therapy with lactulose, rifaximin or other treatment for hepatic encephalopathy.
• Prior episodes of overt HE
• MMSE <25
• TIPS placement
• Unable to give informed consent.
• Contra-indications to MRI