Introduction

Inflammatory Bowel Disease (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), is a chronic inflammatory condition affecting the gastrointestinal tract. Although primarily associated with intestinal symptoms, IBD has also been linked to various extraintestinal complications, including liver fibrosis (LF). Additionally, metabolic-associated steatotic liver disease (MASLD), a common liver condition driven by metabolic risk factors such as obesity and insulin resistance, could intersect with IBD, given its systemic nature.
While both LF and MASLD are prevalent among the general population, their incidence and associated risk factors in IBD patients remain underexplored. Understanding these liver-related complications is crucial for developing effective screening and management strategies for patients with IBD.

Aims & Methods

We aimed to assess the prevalence of LF and MASLD in IBD patients compared to matched controls. In this cross-sectional, case-control study, we enrolled consecutive IBD patients from an IBD referral center and matched controls from the general population based on age, sex, type 2 diabetes (T2D) status, and body mass index (BMI) in a 1:1 ratio. Liver fibrosis and MASLD were confirmed through shear-wave elastography (SWE) measurements of stiffness and attenuation coefficient. Potential risk factors were analyzed using multivariate logistic regression.

Results

We included 378 participants, comprising 200 IBD patients (106 with CD and 94 with UC) and 178 controls. There were no statistically significant differences regarding distribution by gender, age, T2D status and BMI. The prevalence of LF (SWE ≥ 6.78 kPa) and advanced LF (SWE ≥ 9.15 kPa) was 42.5% and 16.0%, respectively, in IBD patients (48.1% in CD vs. 36.2% in UC; p=0.088) and 28.1% and 9.0%, respectively, in the control group (p<0.05). For UC, history of complicated disease (OR 7.5, CI95% 1.2-46.2 p<0.05) and multiple hospitalizations due to acute disease (OR 5.6, CI95% 1.3-24.8; p<0.05) were significant risk factors. As for CD, previous hospitalizations (OR 9.7, CI95% 1.4-65.8; p<0.05) and heavy smoking habits (OR 4.9, CI95% 2.0-12.4; p<0.001) were the main risk factors. Extraintestinal manifestations, higher fecal calprotectin level at the time of liver stiffness measurement and latest endoscopic activity were not associated with presence of LF. MASLD was not significantly different between IBD and control group (42.0% vs. 51.7%, respectively; p>0.05). Higher BMI, higher waist circumference, higher abdominal wall thickness and metabolic syndrome were significant risk factors for MASLD (p<0.001).

Conclusion

Our case-control study demonstrates that patients with IBD have a higher prevalence of liver fibrosis compared to matched controls, with significant risk factors including a history of complicated disease, multiple hospitalizations, and heavy smoking habits. Conversely, the prevalence of MASLD does not significantly differ between IBD patients and controls, suggesting that metabolic factors might play a more substantial role in MASLD risk. Given these findings, it is critical for clinicians to implement routine liver fibrosis surveillance in IBD patients, especially in those with identified risk factors. Proactive management strategies aimed at reducing risk factors, such as smoking cessation and minimizing hospitalizations through effective disease management, could mitigate liver fibrosis risk in this population. These insights emphasize the need for integrated care approaches that address both IBD-related complications and associated liver health.