P0390Prospective Cohort Analysis of Hepatobiliary Manifestations in Korean Patients with Inflammatory Bowel Disease: A Distinctive Insight from an Asian Population

Background Hepatobiliary disorders are clinically important extraintestinal manifestations of inflammatory bowel disease (IBD), yet prospective data from Asian populations are limited. This study prospectively evaluated the prevalence, risk factors, and clinical correlations of hepatobiliary involvement in Korean patients with IBD. Methods In this prospective observational cohort, 415 patients with confirmed IBD (ulcerative colitis [UC] = 241; Crohn’s disease [CD] = 174) were systematically enrolled and followed at a tertiary referral center (2018–2025). All underwent abdominal ultrasonography and transient elastography (FibroScan®). Clinical, metabolic, and inflammatory parameters were prospectively recorded. Multivariable logistic regression and correlation analyses identified independent determinants of hepatobiliary abnormalities. Results NAFLD was identified in 59 patients (14.2%) and biliary disease in 55 (13.2%). Among those with NAFLD, 30 had UC and 29 had CD, and mean age was higher in UC (47.9 ± 14.3) than CD (38.5 ± 18.9 years, P = 0.036). Female sex (aOR 2.30, 95% CI 1.21–4.35, P = 0.011), BMI (aOR 1.21, 95% CI 1.11–1.31, P < 0.001), triglycerides (aOR 1.01, 95% CI 1.00–1.01, P = 0.024), and fecal calprotectin (aOR 1.003, 95% CI 1.001–1.008, P = 0.008) independently predicted NAFLD, while disease duration and alcohol intake were not significant. CAP correlated positively with BMI (r = 0.45, P < 0.001) and inversely with fecal calprotectin (r = −0.21, P < 0.001). In subgroup analyses, CAP–BMI correlation persisted in UC (r = 0.48) and CD (r = 0.44, both P < 0.001). Liver stiffness correlated with disease duration (r = 0.29, P < 0.001) and ALT (r = 0.32, P < 0.001) in CD but not UC. Mean liver stiffness was 5.2 ± 2.5 kPa, FIB-4 index 0.78 ± 0.51, and NAFLD fibrosis score −3.18 ± 1.60; significant fibrosis (≥F2) occurred in 10.2%, while 89.8% remained non-fibrotic. CD subtype was the only independent predictor of biliary disease (aOR 1.69, 95% CI 1.05–2.71, P = 0.03). UC patients had higher CAP (227.3 ± 52.3 vs 212.1 ± 55.3 dB/m, P = 0.005), cholesterol (P = 0.01), and HDL (P = 0.002), whereas CD had higher CRP (P < 0.001), lower albumin (P < 0.001), longer disease duration (P = 0.02), and more prior bowel resection (P = 0.04). Conclusion This prospective Korean cohort provides the first comprehensive quantitative analysis of hepatobiliary manifestations in Asian IBD patients. Female, BMI, triglycerides, and intestinal inflammation were key determinants of NAFLD, while CD conferred a higher risk of biliary disease. These findings highlight the metabolic–inflammatory interplay underlying hepatobiliary complications and underscore the need for region-specific, prospective surveillance strategies in IBD management. Reference: 1. Principi M, Iannone A, Losurdo G, Mangia M, Shahini E, Albano F, et al. Nonalcoholic fatty liver disease in inflammatory bowel disease: prevalence and risk factors. Inflamm Bowel Dis. 2018;24(7):1589–1596. Conflict of interest: Prof. Dr. Moon, Won: No conflict of interest Lee, Jong Hoon: NO COI Seo, Kwang Il: No conflict of interest