الفهرس 
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Abstract
Introduction:
Minimal hepatic encephalopathy (MHE), previously known as subclinical or latent hepatic encephalopathy is at the beginning of this spectrum. It is defined as HE without symptoms on clinical/neurological examination, but with deficits in some cognitive areas that can only be measured by neuropsychometric testing.
Aim of the work:
Our study aimed to compare lactulose, L-ornithine L-aspartate (LOLA), rifaximin and their combination on the treatment of minimal hepatic encephalopathy and the effect on health-related quality of life (HRQOL) assessed by the perceived stress score (PSS) questionnaire.
Patients and methods:
Patients with MHE were allocated randomly to four different treatment protocols for 2 months in addition to control group (group1):
1. Lactulose therapy (group 2): 30-60 ml/day to cause 2-3 semi-formed stools.
2. L-ornithine l-aspartate (LOLA) therapy (group 3): 6 g three times per day.
3. Rifaximin therapy (group 4): 400 mg three times per day.
4. Combined therapy (group 5): it included combination of all the above drugs.
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NCT, SDT, CFF, arterial ammonia level and PSS questionnaire were repeated after one and two months of therapy [end of therapy].
The results of this study was statistically analyzed and listed in tables and figures.
Results:
One hundred and twenty six (71.1%) of 177 patients with liver cirrhosis had MHE.
After 2 months, MHE improved significantly in all our treatment groups.
It was founded that LOLA decreases ammonia level more than lactulose and rifaximin.
There was no significant difference between patients treated with lactulose, LOLA, rifaximin and combined therapy.
Lactulose the most economic drug in treatment of MHE according our study.