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Additionally, a systematic review of nine randomized control trials (RCTs) concluded that probiotics were associated with improvement in mHE, prophylaxis of OHE and reduction in severe adverse events [87]

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Mechanisms of benefit may include both weight reduction and direct pharmacological effects, such as reduced cerebrospinal fluid secretion via GLP-1 receptors in the choroid plexus, and anti-inflammatory/neuroprotective actions in the brain