Microbiota trAnSplant ThERaPy In hEpatiC Encephalopathy (MASTERPIECE)

Inclusion Criteria: * 21 years of age * Cirrhosis diagnosed by any of the following in a patient with chronic liver disease * Liver Biopsy * Radiologic evidence of varices, cirrhosis or portal hypertension * Laboratory evidence of platelet count \<110,000 or AST/ALT ratio\>1 * Endoscopic evidence of varices or portal hypertensive gastropathy * Prior overt HE (patient can be on lactulose and/or rifaximin 4 weeks stable dosing) * Able to give written, informed consent \[mini-mental status exam (MMSE)\]\>25 at the time of consenting) * For lactulose only group: Prior HE not on rifaximin Exclusion Criteria: * Disease-related: * MELD3.0 score\>22 * WBC count\<1000 * non-elective hospitalization or overt HE episode within 1 month * on dialysis * known untreated, luminal GI cancer * chronic intrinsic GI diseases (ulcerative colitis, Crohn's disease, microscopic colitis, eosinophilic gastroenteritis or celiac disease) * Safety-related: * Current dysphagia * History of aspiration, intestinal obstruction or non-medication induced gastroparesis * Ongoing absorbable antibiotic use * History of anaphylactic food allergy * Allergy to ingredients in the capsules (glycerol, sodium chloride, hypromellose, gellan gum, titanium dioxide, theobroma oil) * Adverse event attributable to prior FMT (7) ASA Class V * Pregnant or nursing patients * Acute illness or fever on the day of planned FMT * History of spontaneous bacterial peritonitis