The purpose of a new study published in Digestive Diseases was to characterize active bacterial assemblages in the duodenum and feces in patients with minimal hepatic encephalopathy (MHE) before, during, and after long-term therapy with rifaximin. In this study, the gut microbiota composition of 5 patients with liver cirrhosis and MHE, who had been treated either with rifaximin 550 mg bid alone continuously for a period of 3 months or combined with lactulose 30-60 mL daily for 3 months, were analyzed. In addition to clinical assessments of HE, biopsies from duodenum and stool samples were assessed for specific bacterial community before treatment, after 3 months of treatment and 3 months after the end of treatment. The results revealed that all 5 patients had a significant improvement of their MHE, however, bacterial communities were different and distinct in their duodenal samples and feces. Meanwhile, no statistically significant changes were noted in the bacterial community profile at the different time points. Hence, it was inferred that rifaximin therapy with and without lactulose over a period of 3 months does not affect the bacterial community composition. The improvement of HE with rifaximin lasts even after the end of treatment, and therefore, it implicates a prolonged effect on microbiota metabolic function.