Racial, Ethnic, and Immigration-Related Disparities Across the Gastrointestinal Care Continuum: A Scoping Review

Abstract

Background: Gastrointestinal (GI) diseases contribute substantially to healthcare utilization and chronic disease burden through recurrent symptoms, ongoing specialist care, and diagnostic evaluation. However, disparities related to race, ethnicity, and immigration status may arise at multiple points along the GI care continuum, and their association with access, diagnosis, treatment, and outcomes remains incompletely characterized. This scoping review synthesizes evidence on these differences in GI healthcare delivery. Methods: MEDLINE and Embase were searched from 1 January 2000 to 17 June 2025, with supplementary grey literature searches of relevant GI, liver, surgical, and endoscopic society websites. Findings were synthesized thematically due to heterogeneity in study design, populations, outcomes, and reporting. Results: Seventy-four studies were included across various GI diseases, including inflammatory bowel disease, hepatobiliary disease, esophageal disorders, and liver transplantation. Differences in care were reported across multiple care stages, including specialist access; diagnostic and treatment delays; use of medical, procedural, and surgical therapies; emergency care reliance; and transplant access and outcomes. Findings were, however, heterogeneous, with some studies reporting no differences or higher utilization among minority groups. Conclusions: Racial, ethnic, and immigration-related differences are reported across GI care pathways. Future research should identify modifiable factors that may lead to practice-changing interventions that will improve timely, equitable, longitudinal care.