Rifaximin in Minimal Hepatic Encephalopathy

Inclusion Criteria: * Age 18-65 years * Cirrhosis diagnosed on clinical grounds * MHE diagnosed by abnormalities in a psychometric battery (NCT-A, NCT-B, ICT BDT and DST impaired beyond 2 standard deviations of known control values on any of the above 3 tests will be considered to have MHE) * Current drivers (valid driving license and driving at least 20 miles/week) * All women of child-bearing potential will be required to use effective contraception Exclusion Criteria: * Current or recent (\< 6 month) use of alcohol (AUDIT questionnaire will be used; any cirrhotic with a value of \> 0 will be excluded) and a positive blood alcohol level * Use of antibiotics within last 6 weeks * Allergy to rifaximin, rifabutin, rifampin, or rifapentine * Infection or gastrointestinal hemorrhage within the last 6 weeks * Renal insufficiency * Hepatocellular carcinoma * Psychoactive drug use, including interferon concurrently * Non-drivers and those who drive less than 20 miles/week * Pregnancy and breastfeeding * Excluding patients with OHE: * Detailed neurological examination to check for dysarthria, asterixis, ataxia and disorientation * Detailed history-taking from friends/relatives only after taking the patient's permission * Mini-mental status examination \> 25 * Episode of overt (clinical hepatic encephalopathy) within 6 months * Current treatment with lactulose, rifaximin, zinc, or metronidazole