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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
From gut to liver: Exploring the relationship between inflammatory bowel disease and metabolic dysfunction-associated steatotic liver disease
Marina Amorim Lopes, Ellen Cristina Souza Oliveira, Ana Elisa Valencise Quaglio, Andrey Santos, Marcello Imbrizi, Leticia Evelyn Rocha Mendes, Rodrigo Fedatto Beraldo, Julio Pinheiro Baima, Amanda Luísa Spiller, Daniéla Oliveira Magro, Ligia Yukie Sassaki
Marina Amorim Lopes, Ellen Cristina Souza Oliveira, Leticia Evelyn Rocha Mendes, Julio Pinheiro Baima, Amanda Luísa Spiller, Ligia Yukie Sassaki, Department of Internal Medicine, Medical School, São Paulo State University (UNESP), Botucatu 18618-687, São Paulo, Brazil
Ana Elisa Valencise Quaglio, Verum Ingredients, Botucatu Technology Park, Botucatu 18605-525, São Paulo, Brazil
Andrey Santos, Department of Internal Medicine, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-887, São Paulo, Brazil
Marcello Imbrizi, Daniéla Oliveira Magro, Division of Gastroenterology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-970, São Paulo, Brazil
Rodrigo Fedatto Beraldo, Faculdade de Medicina, Fundação Dracenense de Educação e Cultura (FUNDEC), Dracena 17910-106, São Paulo, Brazil
Author contributions: Lopes MA, Oliveira ECS, Quaglio AEV, Santos A, Imbrizi M, Mendes LER, Beraldo RF, Baima JP, Spiller AL, Magro DO and Sassaki LY contributed equally to the conception and design of the article, writing, and editing of the manuscript, and review of the literature; all the authors approved the final version of the article to be published.
Supported by The São Paulo Research Foundation (FAPESP), Brazil, No. 2022/15527-3; The Postdoctoral Scholarship Grant from Medical School, São Paulo State University, No. PROPG/PROPE N° 06/2024; The Master Scholarship Grant from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil (CAPES)-Programa de Excelência Acadêmica (PROEX), No. 88887.807663/2023-00.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ligia Yukie Sassaki, MD, PhD, Assistant Professor, Researcher, Department of Internal Medicine, Medical School, São Paulo State University (UNESP), Av. Prof. Montenegro-Distrito de, Botucatu-SP, Botucatu 18618-687, São Paulo, Brazil.
ligia.sassaki@unesp.br
Received: April 28, 2025
Revised: June 2, 2025
Accepted: August 20, 2025
Published online: September 27, 2025
Processing time: 150 Days and 14.3 Hours
Inflammatory bowel disease (IBD), comprising Crohn’s disease and ulcerative colitis, is a chronic condition marked by relapsing inflammation of the gastrointestinal tract. Metabolic dysfunction-associated steatotic liver disease (MASLD) emphasizes the interplay between metabolic alterations and modern lifestyle factors in its pathogenesis. Emerging evidence suggests that individuals with IBD are at increased risk for MASLD, driven by shared mechanisms, including gut dysbiosis, chronic systemic inflammation, and compromised intestinal barrier function. However, MASLD frequently remains underdiagnosed in this population. The gut microbiota plays a central role in modulating these interactions, influencing both intestinal permeability and metabolic regulation. Key pathophysiological mechanisms include alterations in short-chain fatty acid production, particularly reduced butyrate synthesis; disruption of bile acid signaling pathways via farnesoid X receptor and Takeda G protein–coupled receptor 5 receptors; and activation of pro-inflammatory cascades through toll-like receptor 4 in the liver. These events lead to increased intestinal permeability, translocation of microbial products, and amplification of hepatic inflammation. This review synthesizes current knowledge on the shared pathophysiological pathways linking IBD and MASLD–focusing on dysbiosis, barrier dysfunction, and inflammation–and underscores their clinical relevance. Understanding the gut–liver axis provides opportunities for early diagnosis and integrated management strategies, aiming to reduce disease burden and improve patient outcomes.
Core Tip: This review explores the complex interplay between inflammatory bowel disease (IBD) and metabolic dysfunction-associated steatotic liver disease, two increasingly prevalent conditions with shared key pathophysiological mechanisms. Chronic inflammation, gut dysbiosis, and intestinal barrier dysfunction are central to both diseases and interconnected through the gut–liver axis. Understanding this relationship highlights the importance of metabolic monitoring, lifestyle interventions, and early screening of hepatic and cardiovascular complications in patients with IBD.
