Inflammatory bowel disease (IBD) is frequently complicated by hepatobiliary conditions, including metabolic dysfunction-associated steatotic liver disease (MASLD), drug-induced liver injury, primary sclerosing cholangitis, and autoimmune liver disease. However, systematic liver assessment remains underused, and serum indices such as FIB-4 may be confounded by IBD-related thrombocytosis. Transient elastography (TE) quantifies liver stiffness measurement (LSM) for fibrosis and the controlled attenuation parameter (CAP) for steatosis through a rapid, noninvasive outpatient examination. This narrative review synthesizes evidence on the prevalence of fibrosis and steatosis, associated risk factors, the effects of IBD therapies, and the clinical utility of TE-based screening, drawing on original studies that used FibroScan®-based LSM and/or CAP in adult patients with IBD; studies using other elastography modalities were excluded. Across 13 studies involving more than 2,700 patients with IBD, the prevalence of significant fibrosis (F≥2) clustered around 4–12% (range, ~1–20%, depending on the threshold), while steatosis was detected in 29–46%. Anti-TNF therapy was associated with a lower prevalence of fibrosis, whereas cumulative corticosteroid exposure increased the risk of both fibrosis and steatosis. Two matched-control studies confirmed that IBD independently confers an increased hepatic risk: one reported steatosis in 42.0% versus 32.7% and advanced fibrosis in 9.5% versus 2.3% of controls (adjusted odds ratio [aOR] for steatosis, 1.99), while ELASTIBD reported significant fibrosis in 12.3% versus 4.2% (aOR, 3.31) and steatosis in 41.4% versus 28.3% (aOR, 2.51) compared with matched controls. TE therefore provides actionable information beyond standard liver function tests and should be integrated into IBD follow-up, particularly for patients with prolonged corticosteroid exposure, metabolic comorbidities, or longstanding disease, while standardization of cutoff values and longitudinal data remain research priorities.