Rifaximin Modify the Pathogenesis of Non-Alcoholic Fatty Liver Disease (NAFLD)

Inclusion Criteria: 1. women or men aged 18-65 years. 2. biopsy-proven NASH without or with mild to moderate fibrosis (fibrosis stage 0-3)in the preceding year. 3. persistently abnormal ALT on 2 occasions. 4. participants have provided written informed consent before screening. 5. all patients counseled about the standard of care treatment (e.g., diet andexercise). 6. Strict requirements for weight stability between the time of biopsy and study entry. Exclusion Criteria: 1. Cirrhotic NAFLD (METAVIR stage 4). 2. Combined viral hepatitis B and C infection. 3. increased alcohol intake (\>20 g/day) and hypothyroidism. 4. co-existence of another type of biliary tract or pancreatic or liver diseases 5. lactating or pregnant women. 6. allergy to rifamycin or rifaximin. 7. systemic inflammatory conditions (e.g. Connective tissue diseases and inflammatory bowel diseases). 8. bariatric surgery and blind loop. 9. evidence of hepatic decompensation (ascites, hepatic encephalopathy, and varices), 10. history of myocardial infarction and/ or stroke within 6 months. 11. drugs that alter the gut flora e.g. Lactulose, systemic antibiotic, cholestyramine within three months, (l) cancers especially HCC, and (m)patients with renal impairment (estimated GFR \<60ml/min/1.73m2). (n) Major dose change orintiation of biguanides, metformin, thiazolidinediones, insulin, fibrates, statins, and anti-obesity medications within three months before the onset of the study.