Introduction: It is well-established that central obesity, insulin resistance, and dysplipidemia are common risk factors for the development of non-alcoholic fatty liver disease (NAFLD). Patients with inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), often do not have features of the metabolic syndrome. The chronic inflammatory state of IBD may predispose to development of fatty liver, as inflammation is a part of the pathogenesis of fatty liver. The aim of this study is to determine the prevalence of fatty liver in those with diagnosed IBD. Methods: A retrospective chart review was performed on 300 consecutive outpatients with diagnosis codes consistent with IBD (UC, CD, and indeterminate colitis) from 2009-2015 at a single urban academic medical center. IBD diagnosis was biopsy proven or as confirmed by outpatient gastroenterologist documentation. Patients were excluded if they had co-existing liver disease, history of liver transplantation, or paucity of clinical/laboratory data. Demographic information, in addition to liver function tests, BMI, medications, results of imaging studies, and comorbidities, including hypertension and diabetes were recorded. ALT values were deemed abnormal if value > 29. Results: Of the 300 patients with IBD reviewed, 201 patients met criteria and were included in the study. There were 74 patients (36.8%) with an ALT >29. Of those with elevated ALT, 34.1% had UC, and 38.6% had CD. Of those with an ALT >29, 38.0% of patients did not have any follow-up imaging performed. Of those who had imaging, 29.0% (8 patients) had evidence of either steatosis or fatty infiltration. Those who were noted to have hepatic steatosis or fatty liver had mean BMI 32.4, (range 19-46). This compares to an average BMI of 27.1 (range 15-47) for the 199 patients in the IBD cohort that had BMI available. Of the 8 patients who had radiographic evidence of steatosis or fatty infiltration, 50% of them had evidence of HTN and DM. Four of the 8 patients were also actively getting anti-TNF medications. Conclusion: Almost a third of patients with IBD had ALT elevation, and a third of these patients were found to have radiographic evidence of steatosis. Our study confirms the high prevalence of ALT elevation in IBD patients of which a large percentage could be attributable to NAFLD. NAFLD is a potentially serious cause of liver injury and IBD patients, specifically those with metabolic syndrome, may be at increased risk.