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The mainstay of treatment of hepatic encephalopathy is lactulose and lactitol, laxative agents that can be considered as prebiotics as they lower blood ammonia concentrations, possibly by favoring colonization with acid-resistant, non-urease producing bacteria

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Experimental animals All animal experimental protocols were in accordance with the ethical guidelines for Animal Experimentation of the National Research Council of Thailand and were approved by the Animal Ethics Committee of Khon Kaen University (IACUC-KKU-65/65 and IACUC-KKU-52/61)