Patients with end stage of liver disease or cirrhosis can develop confusion due to high
ammonia and inflammation. This confusion is brought upon by changes in the bacteria in the
bowels and may not respond to current standard of care treatments. Repeated episodes of
confusion can make it difficult for patients to function and may result in multiple
admissions to the hospital and burden on the family. The investigators have studied using a
healthy person's stool to replace the bowel bacteria, called fecal microbial transplant, in
small studies with good results. In this trial the investigators propose to perform these
procedures using an upper and lower route in Veterans who suffer from this condition and
follow them for safety and hospitalizations over 6 months. The investigators will compare
this to placebo treatments and hope that this intervention can improve the health and daily
functioning of affected patients.