The purpose of this study is to examine S.endotoxins , inflammatory mediators and Magnetic Resonance Spectroscopy (MRS) before and after treatment in patients of cirrhosis and minimal hepatic encephalopathy.

60 patients of cirrhosis with Minimal Hepatic Encephalopathy (MHE) who fulfills the inclusion & exclusion criteria will be the part of study. Study patients will be divided in to two groups ( n=30 in each group).

Group L patients will receive lactulose therapy while Group NL will receive placebo. After 3 months , S.endotoxins , inflammatory mediators and MRS will be repeated in each group.

Inclusion Criteria:

• Clinical diagnosis of Cirrhosis (Age 15 yr -70 yr )

Exclusion Criteria:

• Recent history of gastrointestinal bleed in last 6 weeks
• Active ongoing infection
• Creatinine >1.5mg%
• Electrolyte impairment. (S. Sodium < 130 meq/L, S. Potassium 3.5 meq/L or >5.0meq/L)
• H/O use of psychotropic drugs in last 6 weeks
• Recent alcohol use (< 6 week )
• H/O TIPS or shunt surgery.
• Hepatocellular Carcinoma
• Severe comorbidity as Congestive Heart Failure, Pulmonary disease, Neurological and Psychiatric problems impairing quality of life
• Poor vision precluding neuropsychological assessment