Diseases of the liver are commonly encountered in patients with inflammatory bowel disease (IBD). While the differential diagnosis for IBD patients with elevated liver associated enzymes is broad, it is similar to that of the general population, including nonalcoholic fatty liver disease (NAFLD): The most common liver disease in North America. When initial workup for elevated liver associated enzymes is negative and patients have steatosis on ultrasound, we counsel IBD patients aggressively about weight loss in order to prevent the progression of liver disease. Here, we describe the association between liver disease and IBD and illustrate an approach to management of elevated liver associated enzymes in this unique patient population.