Abstract Background Patients with inflammatory bowel disease (IBD) show increased risk of liver involvement, most commonly metabolic dysfunction–associated steatotic liver disease (MASLD). However, systematic hepatological screening in IBD cohorts remains uncommon. Transient elastography (FibroScan®) provides a simple, non-invasive way to detect subclinical hepatic steatosis and fibrosis. Methods The prevalence and predictors of hepatic steatosis and fibrosis were evaluated in an unselected IBD cohort of fifty-four patients (Crohn’s disease and ulcerative colitis) who underwent transient elastography (FibroScan®).Significant steatosis was defined as a controlled attenuation parameter (CAP) 275 dB/m, and significant fibrosis as liver stiffness measurement (LSM) 8.0 kPa. Demographic data, metabolic comorbidities, and current IBD therapies were recorded.Group comparisons were performed using t-tests and Fisher’s exact test, and multivariate logistic regression was applied to identify independent predictors. Results Steatosis (CAP 275 dB/m) was found in 26% of patients and was more common among those with DM (35% vs 5.9%, p = 0.009). Dyslipidemia and hypertension showed non-significant trends. No difference was seen between Crohn’s disease and ulcerative colitis. Subclinical fibrosis (LSM 8 kPa) was found in 7.4% of patients, most of whom already had known liver disease (autoimmune hepatitis, PSC, or alcohol abuse). In multivariate analysis, DM was the only independent predictor of steatosis (OR 7.9, 95% CI 1.25–50.1; p = 0.028). BMI showed a positive trend (OR 1.13, p = 0.098). No predictors of fibrosis were identified. No significant association was observed between IBD therapy and steatosis or fibrosis, although a non-significant trend (p = 0.077) was noted in patients on immunomodulators (mainly azathioprine). Conclusion Systematic transient elastography in IBD patients showed a prevalence of MASLD comparable to the general population. Steatosis was mainly related to metabolic risk—especially diabetes, independent of obesity—rather than to IBD activity, type, or therapy. Subclinical fibrosis was rare (7.4%) and mostly due to pre-existing liver disease.These findings indicate that IBD patients do not represent a high-risk group for disease-specific liver injury. Hepatic involvement appears mainly metabolic in origin and therefore potentially modifiable. Routine use of transient elastography may not be warranted, whereas clinical attention should focus on comprehensive metabolic risk assessment and prevention. Conflict of interest: Dr. Serio, Mariaelena: No conflict of interest Ridolfi, Francesco: No conflict of interest Maltoni, Stefania: No conflict of interest Scorzoni, Chiara: No conflict of interest Seri, Cinzia: No conflict of interest Ortolani, Alessio: No conflict of interest Graziosi, Amalia: No conflict of interest Falcioni, Giorgia: No conflict of interest Scarcelli, Antonella: No conflict of interest
Serio et al. (Thu,) studied this question.