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19 There are multiple problems with the trials assessing the use of rifaximin, 20 such as confounding effects of transjugular intrahepatic portosystemic shunt (TIPS) and surgical portosystemic shunts, 17 randomization imbalance, 21,22 lack of benefit in high risk populations (such as in prevention of HE in those undergoing TIPS), 23 and absence of objective HE scales in outcome assessment in some of the studies

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