METABOLIC-INFLAMMATORY INTERACTIONS IN INFLAMMATORY BOWEL DISEASE AND MASLD: THE GUT-LIVER AXIS AS A LINK BETWEEN DYSBIOSIS, SYSTEMIC INFLAMMATION AND HEPATIC FIBROSIS

Abstract

The coexistence of inflammatory bowel disease (IBD) and metabolic dysfunction-associated steatotic liver disease (MASLD) represents a clinically important example of interaction between chronic intestinal inflammation and systemic metabolic dysfunction. This review summarizes contemporary evidence on the mechanisms connecting intestinal barrier failure, dysbiosis, microbial translocation, cytokine activation, oxidative stress, insulin resistance and bile-acid signaling with hepatic steatosis and fibrogenesis. Particular attention is paid to the gut-liver axis as a dynamic bidirectional system rather than a single pathogenetic pathway. In patients with IBD, metabolic risk may coexist with disease-specific determinants, including chronic inflammatory activity, corticosteroid exposure, nutritional imbalance and altered body composition. These factors may modify the probability of MASLD even in patients without marked obesity. The available evidence also indicates that fibrosis, rather than steatosis alone, is the most clinically relevant hepatic outcome. Therefore, assessment of patients with IBD should integrate metabolic profiling, liver biochemistry and non-invasive fibrosis evaluation when clinically indicated. The review highlights the need for prospective studies combining microbiome, metabolic, inflammatory and elastographic data and supports a multidisciplinary approach to patients with concomitant IBD and MASLD. Keywords: metabolic dysfunction-associated steatotic liver disease; inflammatory bowel disease; gut-liver axis; dysbiosis; systemic inflammation; cytokines; bile acids; liver fibrosis.