VE303 for Treatment of Hepatic Encephalopathy (HE)

Inclusion Criteria: * Diagnosis of cirrhosis based on liver biopsy, imaging, or evidence of clinical decompensation * History of at least one episode of overt HE any time in the past * Prescribed both lactulose and rifaximin, and compliant with this treatment Exclusion Criteria: * Current episode of overt HE * Variceal bleeding in the last 4 weeks * Gut-absorbable or intravenous antibiotic therapy in the last 28 days * Fecal microbiota transplant in the last 6 months * Use of probiotics in the last 2 weeks * Alcohol or illicit drug intake in the last 4 weeks * Primary sclerosing cholangitis as etiology of liver disease * History of inflammatory bowel disease, short gut, gastrointestinal tract fistulas, intestinal ischemia, or any form of ongoing colitis * Prior diagnosis of dementia or other primary neurocognitive disorder * Known hypersensitivity/allergy/intolerance to Vancomycin and any ingredients of VE303: sucrose, histidine, yeast extract, cysteine, metabisulfite, and microcrystalline cellulose * History of Roux-en-Y Gastric bypass * Any gastrointestinal surgery in the last year * Substantial immune compromise/deficiency (e.g., uncontrolled human immunodeficiency virus, active immune suppressive therapy including high doses of corticosteroids or medications to prevent graft rejection, recent myeloablative therapy, sustained neutropenia) * Pregnancy or breast feeding * Model for end-stage liver disease (MELD) \> 20 * History of spontaneous bacterial peritonitis * Hemodialysis in the last 28 days * Placement of a portosystemic shunt or transjugular intrahepatic portosystemic shunt in the last 3 months (permissible if placed \>3 months before enrollment) * Unstable doses of opiates, benzodiazepines or other sedating medication * Chronic methadone or low dose benzodiazepines (for example) is acceptable