Liver fibrosis and steatosis in inflammatory bowel disease: a cross-sectional matched-control Transient Elastography Study (ELASTIBD)

Abstract

Background Metabolic dysfunction–associated steatotic liver disease (MASLD) and liver fibrosis are increasingly recognized as extraintestinal complications of inflammatory bowel disease (IBD)1,2. Their prevalence and therapeutic determinants in real-world IBD populations remain insufficiently defined. Methods We performed a cross-sectional baseline analysis of the ongoing ELASTIBD cohort. A total of 358 adults with IBD and 358 controls individually matched for age, sex, BMI, and diabetes underwent vibration-controlled transient elastography (VCTE; FibroScan®). Hepatic steatosis and fibrosis were assessed using established cut-offs. Clinical and treatment-related predictors were explored with multivariable logistic regression. Results IBD patients demonstrated higher rates of significant fibrosis (12.3% vs 4.2%; adjusted odds ratio [aOR] 3.31, 95% CI 1.75–6.26), advanced fibrosis (4.7% vs 0.6%; p < 0.001), and steatosis (41.4% vs 28.3%; aOR 2.51, 95% CI 1.66–3.79) compared with matched controls. Among IBD patients, those with fibrosis were less frequently exposed to anti-TNF therapy (44.4% vs 68.5%; p = 0.004). In adjusted analyses, anti-TNF exposure was independently associated with reduced fibrosis risk (aOR 0.39, 95% CI 0.16–0.95), while each course of corticosteroids conferred a 41% increase in odds of fibrosis (aOR 1.41, 95% CI 1.04–1.92). Older age (per 10 years: aOR 1.92, 95% CI 1.35–2.72) and higher BMI (per 5 kg/m²: aOR 1.76, 95% CI 1.24–2.51) were also significant predictors. Conclusion IBD patients carry a threefold higher burden of liver fibrosis and a twofold higher burden of steatosis compared with matched controls, consistent with prior elastography-based cohorts1,2, emphasizing the need for systematic liver assessment in IBD care. The inverse association between anti-TNF therapy and fibrosis suggests that effective inflammation control may attenuate hepatic fibrogenesis, in line with experimental evidence supporting the hepatoprotective potential of TNF-α blockade3, whereas repeated corticosteroid exposure appears harmful. These findings highlight the importance of prospective follow-up of the ELASTIBD cohort to clarify long-term trajectories, treatment effects, and patient outcomes. References: 1. Rodriguez-Duque JC, Calleja JL, Iruzubieta P, et al. Increased risk of MAFLD and Liver Fibrosis in Inflammatory Bowel Disease Independent of Classic Metabolic Risk Factors. Clin Gastroenterol Hepatol. Feb 3 2022;doi:10.1016/j.cgh.2022.01.039 2. Saroli Palumbo C, Restellini S, Chao CY, et al. Screening for Nonalcoholic Fatty Liver Disease in Inflammatory Bowel Diseases: A Cohort Study Using Transient Elastography. Inflamm Bowel Dis. Jan 1 2019;25(1):124-133. doi:10.1093/ibd/izy200 3. Lopetuso LR, Mocci G, Marzo M, et al. Harmful Effects and Potential Benefits of Anti-Tumor Necrosis Factor (TNF)-alpha on the Liver. Int J Mol Sci. Jul 27 2018;19(8)doi:10.3390/ijms19082199 Conflict of interest: Dr. Agargun, Besim Fazil: No conflict of interest Senkal, Ibrahım Volkan: No conflict of interest Rustamzade, Aynura: No conflict of interest Nuriyev, Kanan: No conflict of interest Istemihan, Zülal: No conflict of interest Imanov, Ziya: No conflict of interest Genc Ulucecen, Sezen: No conflict of interest Kemik, Fatih: No conflict of interest Karaketir, Emine Şeyma: No conflict of interest Çelik, Bilal: No conflict of interest Şahutoğulları, Dilan: No conflict of interest Cavus, Bilger: No conflict of interest Ormeci Çifcibaşi, Asli: No conflict of interest Demir, Kadir: No conflict of interest Besisik, Fatih: No conflict of interest Kaymakoglu, Sabahattin: No conflict of interest Akyüz, Filiz: No conflict of interest