From:  Minimal hepatic encephalopathy: a hidden threat to quality of life in cirrhosis patients

 Management strategies for MHE [3641]

Management strategiesExamplesMechanism/Effect
PharmacologicalLactulose (20–30 g/day)Acidifies gut, reduces ammonia
Rifaximin (550 mg BID)Modulates gut microbiota
L-ornithine L-aspartate (LOLA)Enhances urea cycle
Non-pharmacologicalProbiotics/synbioticsRestores gut microbiota balance
Cognitive rehabilitationImproves attention/memory
Plant-based dietLowers ammonia production

MHE: minimal hepatic encephalopathy; BID: per 12 hours a day