Inflammatory bowel diseases are associated with an increased risk of liver cirrhosis in a population-based study

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Background Inflammatory bowel disease (IBD) incidence is increasing globally. Hepatobiliary involvement, including primary sclerosing cholangitis and steatotic liver disease, is common. However, data on IBD’s influence on liver cirrhosis occurrence remain scarce. This study explored the association between IBD and the incidence of liver cirrhosis diagnoses in a large German primary care cohort over a twenty-year period. Methods Patients with IBD (10,264 with Crohn’s disease, 13,228 with ulcerative colitis) were matched 1:5 to non-IBD individuals based on age, sex, index year, and co-diagnoses of obesity, diabetes mellitus, and alcohol addiction. The primary outcome was the incidence of liver cirrhosis. Associations were assessed using univariable Cox regression analysis. Results We compared 23,492 IBD patients with 117,460 matched controls. During follow-up of up to 20 years, liver cirrhosis was diagnosed in 1.68% of IBD patients versus 0.68% of controls (p=0.001). IBD was associated with an increased risk of cirrhosis (HR: 1.51; 95% CI: 1.18–1.93). Ulcerative colitis was significantly associated with cirrhosis development (HR: 1.59; 95% CI: 1.16–2.18), whereas Crohn’s disease was not. The association was stronger and statistically significant in individuals aged≥50 years (HR: 1.56; 95% CI: 1.19–2.04), but not in younger individuals, and more pronounced in women (HR: 1.83; 95% CI: 1.28–2.62) than men (HR: 1.29; not significant). Conclusion IBD is associated with an increased risk of a cirrhosis diagnosis, with older patients appearing to be particularly vulnerable. Greater awareness and early identification of liver involvement may help prevent progression to cirrhosis. Publication History Article published online: 26 January 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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