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
Agargun et al. (Thu,) studied this question.