P0389Beyond the gut: The Impact of IBD-related inflammation on hepatic fibrosis

Abstract Background Metabolic dysfunction–associated steatotic liver disease (MASLD) is increasingly prevalent worldwide. It may occur independently but is also the most frequent extraintestinal manifestation of inflammatory bowel disease (IBD). Given its clinical relevance and the recent approval of the first targeted therapy, this study assessed MASLD risk in patients with Crohn’s disease (CD) and ulcerative colitis (UC) to support early detection and prevention. Evidence suggests that heightened inflammatory activity in IBD contributes to or reflects liver fibrosis, indicating that inflammation extends beyond the gut and may influence MASLD/MASH-related progression. Methods We conducted a prospective study of 58 patients with confirmed IBD. Disease type was not independently associated with liver steatosis or fibrosis. The study aimed to identify risk factors for MASLD by examining associations between systemic inflammation (CRP), intestinal inflammation (fecal calprotectin), and fibrosis severity. Associations were first evaluated using the Kruskal–Wallis test. Due to the small number of advanced fibrosis cases, a bootstrap resampling method was applied to strengthen statistical reliability. This analysis revealed significant associations between CRP and fibrosis grade (p = 0.016) and between fecal calprotectin and fibrosis grade (p = 0.022), supporting the involvement of both systemic and intestinal inflammation in hepatic fibrotic changes. Results The cohort included 31 males (53.4%) and 27 females (46.6%), aged 18–75 years (mean 41.88 ± 13.29). The mean age at diagnosis was 35.90 years, and disease duration averaged 5.98 years. Patients with Grade 1 fibrosis had low mean CRP (∼1 mg/dL), whereas the single patient with Grade 2 fibrosis displayed a markedly elevated CRP (20 mg/dL). Despite the limited number of advanced cases, bootstrapping confirmed a significant difference. For intestinal inflammation, Grade 1 fibrosis was associated with high but variable calprotectin levels (mean ∼572 µg/g), while the Grade 2 patient had a lower value (22 µg/g); the bootstrap method again identified a significant association. Conclusion In conclusion, systemic and intestinal inflammation are significantly linked to liver fibrosis severity in IBD. Increased inflammatory activity appears to contribute to or mirror hepatic fibrotic progression, underscoring the importance of early recognition and control of inflammation to reduce MASLD/MASH-related hepatic risk References: 1. Maresca et al. Inflammatory Bowel Diseases and Non-Alcoholic Fatty Liver Disease: Piecing a Complex Puzzle Together. Int. J. Mol. Sci. 2024, 25, 3278. 2. Palumbo et al. Screening for Nonalcoholic Fatty Liver Disease in Inflammatory Bowel Diseases: A Cohort Study Using Transient Elastography. Inflamm. Bowel Dis. 2018, 25, 124–133. CrossRef Conflict of interest: Stemate, Ana: None Negru-Vodă, Delia-Ionela: No conflict of interest Mazurencu-Pele, Patricia: No conflict of interest Negreanu, Lucian: None