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reported improvement in the psychomotor tests in the group of patients with cirrhosis that received Zn supplementation, compared with the group that did not receive it, but unfortunately the difference was not statistically significant.15 In another review article on Zn deficiency, Zn supplementation was suggested for consideration as a therapy in patients that did not respond to treatments based on low-protein diets and the administration of lactulose.16 The benefit of Zn was demonstrated later by the Takuma group through a clinical trial on treatment-refractory cirrhotic patients with grade I and grade II HE

Acknowledgments We would like to thank Editage (www.editage.com) for English language editing

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