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7 randomized trials19–25 provided information on 660 participants with HE, totaling 249 with subclinical hepatic encephalopathy (SHE), 189 with West Haven grade 1, 162 with West Haven grade 2 and 60 with West Haven grade 3 based on the widely used West-Haven criteria introduced by Conn.12 Trials were reported between 2002 and 2011, table 1 summarizes the characteristics of included studies