Table 2.

Characteristics of Other Studies.

Author	Type of Study	Methodology	Results
Fecal microbiota transplantation (FMT)
Yanfei Chen40 – China	Prospective	36 and 24 cirrhotic and control participants were registered, respectively. Fecal microbial communities were explored by 454 pyrosequencing of 16s ribosomal RNA V3 followed by RT-qPCR	•In cirrhosis patients, Bacteroidetes were considerably decreased while Proteobacteria and Fusobacteria were significantly high •Significant prevalence of Enterobacteriaceae, Veillonellaceae, and Streptococcaceae were found in a patient with cirrhosis
Probiotics
Rohan Dalal46	Cochrane review	21 RCTs with probiotics as intervention and placebo (14 studies)/standard care (7 studies) were included with a total of 1420 participants. Range of probiotics was used, VSL#3 was most commonly used.	•No effect on all-cause mortality •Probiotics improved QOL •The probiotic group reported improvement in plasma ammonia levels •The author reported a high risk of systematic and random error in most of the included trial
Arturo J Marti Carvajal72	Cochrane review	RCTs with ALC as the intervention were included. Five trials were included with a total of 398 participants.	•Significant improvement in serum ammonia levels in the case group.
Flumazenil
Goh ET76	Cochrane review	A sum of 14 RCTs was included with 867 participants with cirrhosis and HE. Flumazenil (any dose) and placebo or usual care was used as case and control intervention respectively.	•Flumazenil showed short term benefit on HE, but no evidence on all-cause mortality
Nitazoxanide (NTZ)
Basu P Patrick91 – NY	Prospective pilot study	A sum of 20 patients with cirrhosis was enrolled. The intervention included the use of NTZ 500 mg BD and Lactulose 30 ml BD for 14 days	•Reported improvement in MED and ORT score
A.Elrakaybi92 – Egypt	Open-label, RCT pilot study	A sum of 34 patients was enrolled and randomized into three groups. Nitazoxanide 500 mg BD (12), Metronidazole 250 mg TID (11) and Rifaximin 200 mg TID (11). Lactulose 30–60 ml TID was the common intervention.	•Serum ammonia level in all groups. •NTZ group showed significant improvement in CLDQ and fatigue score
Branched-Chain Amino Acid (BCAA)
Lise Lotte Gluud99	Cochrane review	A sum of 16 RCTs consisting of 827 participants was included. Among 16, 08 trials were with BCAA supplements, and 07 trials were with IV BCAA. The Control group received a placebo in 02 trials, a diet in 10 trials, lactulose in 02 trials, and neomycin in 02 trials.	•Results showed a beneficial effect of BCAA on HE •No significant change in mortality, QOL, and nutritional parameters.
Naloxone (Nal)
Q. Jiang102	Meta-analysis	A sum of 17 RCTs consisting of 1197 participants was included irrespective of language, medication dose, route of administration, blinding, and publication status. Nal (any dose) and placebo or usual care was used as case and control intervention respectively.	•Nal group showed significant improvement in HE •Nal was well tolerated, few patients had episodes of nausea and vomiting

ALC, acetyl-l-carnitine; BCAA, branched-chain amino acid; BD, twice a day; CHESS, Clinical Hepatic Encephalopathy Staging Scale; CLDQ, Chronic Liver Disease Questionnaire; MED, Modified Encephalopathy Scale; Nal, naloxone; ORT, object recognition test; QOL, quality of life; RCT, randomized control trial; RT-qPCR, real-time quantitative polymerase chain reaction; TID, three times a day; VSL#3, high concentration probiotic preparation.