# Multicenter Study of Microbial Profiles for Management of Hepatic Encephalopathy in Veterans with Cirrhosis

> **NIH VA I01** · VA VETERANS ADMINISTRATION HOSPITAL · 2026 · —

## Abstract

Cognitive impairment is epidemic in Veterans with cirrhosis, which poses a major psychosocial, financial, and
clinical burden. While it is assumed that hepatic encephalopathy (HE, both minimal, MHE or overt forms) is the
major cause of this impairment, recent work by our group has shown the frequent other causes/contributors in
up to half of Veterans with cognitive complaints referred to our VAs specialized testing clinic had a non-HE
related cause. The differential diagnosis for non-HE cognitive complaints includes mild cognitive impairment
(MCI) and dementia, mood disorders, post-traumatic stress disorder (PTSD), obstructive sleep apnea (OSA),
and Parkinson’s. A major issue is the lack of confirmatory test(s) for HE and the often-flawed current mode of
clinical diagnosis. As a result, most clinicians treat every Veteran with cirrhosis with cognitive complaints for HE
which results in therapies that are either poorly tolerated (lactulose), or expensive (rifaximin), while ignoring
underlying causes of cognitive complaints. Specialized cognitive testing clinics, detailed inquiry of symptoms,
co-morbid conditions, and interpretation are ideal but not practical without training, expertise, and significant
financial investment. Therefore, we need better strategies to reliably diagnose/exclude HE, which will
minimize unnecessary poorly tolerated and expensive therapy, avoid misdiagnosis in roughly half of
patients, and guide clinicians taking care of Veterans with cirrhosis. Microbiome composition is altered in
patients with HE (both MHE and overt) and predicts clinically relevant outcomes. Our recent research showed
that the gut microbial analysis accurately differentiates between microbial profiles due to addiction disorders,
PTSD, MCI/dementia, and rules out MHE-related cognitive impairment. Specificity of a clinical HE diagnosis
was 50% versus >90% for microbiome profiling when both were compared to the detailed neuropsychological
evaluation. As a result, reliable mi

## Key facts

- **NIH application ID:** 11183157
- **Project number:** 1I01CX002863-01A1
- **Recipient organization:** VA VETERANS ADMINISTRATION HOSPITAL
- **Principal Investigator:** Jasmohan S Bajaj
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2026
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2026-04-01T00:00:00 → 2030-03-31T00:00:00

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11183157

## Citation

> US National Institutes of Health, RePORTER application 11183157, Multicenter Study of Microbial Profiles for Management of Hepatic Encephalopathy in Veterans with Cirrhosis (1I01CX002863-01A1). Retrieved via AI Analytics 2026-07-14 from https://api.ai-analytics.org/grant/nih/11183157. Licensed CC0.

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