Liver fibrosis and steatosis in inflammatory bowel disease: a cross-sectional matched-control transient elastography study (ELASTIBD)

Abstract

Aim Metabolic dysfunction-associated steatotic liver disease (MASLD) and liver fibrosis are emerging extraintestinal manifestations of inflammatory bowel disease (IBD), but their true burden and the impact of therapies on liver health have not been fully elucidated. We aimed to assess the prevalence of hepatic steatosis and fibrosis in IBD versus matched controls and examine associations with therapies, particularly anti-TNF agents and corticosteroids.Methods In this cross-sectional study, 358 adults with IBD and 358 controls individually matched for age, sex, BMI, and diabetes underwent vibration-controlled transient elastography (VCTE; FibroScan). These are the baseline findings of the ongoing ELASTIBD cohort.Results Patients with IBD had higher rates of significant fibrosis (12.3% vs. 4.2%; adjusted odds ratio [aOR] 3.31 and 95% CI 1.75-6.26), advanced fibrosis (6.7% vs. 0.6%; OR 8.50 and 95% CI 1.98-36.52), and steatosis (41.4% vs. 28.3%; aOR 2.51 and 95% CI 1.66-3.79) than controls. Among patients with IBD, anti-TNF therapy was less frequent in those with fibrosis (44.4% vs. 68.5% and p = 0.004) and independently associated with lower odds of fibrosis (aOR 0.39 and 95% CI 0.16-0.95), whereas each steroid course was associated with 41% higher odds (aOR 1.41 and 95% CI 1.04-1.92). Older age and higher BMI were additional predictors.Conclusions Patients with IBD demonstrated threefold higher fibrosis and twofold higher steatosis than matched controls, emphasizing the importance of liver assessment in clinical practice. The inverse association between anti-TNF exposure and fibrosis suggests inflammation control may reduce hepatic fibrogenesis and supports follow-up of the ELASTIBD cohort to clarify progression, treatment effects, and liver outcomes.