INTRODUCTION: Inflammatory bowel disease (IBD) causes chronic inflammation in the gastrointestinal tract, particularly in the colon and small intestine. We aimed to compare the clinical characteristics and long-term outcomes of Arab Bedouin and Jewish IBD patients in the Negev. METHODS: This retrospective case-control study (1:2 matching, controlled for age and sex) included patients of Bedouin Arab (BA) or Jewish origin, aged 18 or older, diagnosed with Crohn's disease (CD) or ulcerative colitis (UC). Data on demographics, disease behavior, outcomes, and mortality were collected. RESULTS: One hundred sixty-seven CD patients and 159 UC patients were included. Fifty-eight (34.7%) of the CD patients and 53 (33.3%) of the UC patients were BA. BA CD patients had a higher proportion of ileal disease (56.9 vs. 35.8%, P = 0.009), and lower healthcare utilization, including fewer emergency department visits (9.4 +/- 8.7 vs. 16.2 +/- 13.8, P < 0.001) and fewer hospitalizations (5.18 +/- 6 vs. 12.2 +/- 12, P < 0.001) than Jewish patients. Treatment disparities showed that AB patients were less likely to receive biological therapies (55.2 vs. 84.4%, P < 0.001). Regarding UC, AB patients had a higher rate of proctitis than Jewish patients (56.6 vs. 29.2%, P < 0.001) and a higher rate of extraintestinal manifestations 41.5 vs. 11.3%, P < 0.001, respectively. In addition, BA UC patients had a lower rate of biological treatment but a higher rate of hospitalization and death. CONCLUSION: The study underscores the need for tailored healthcare strategies for BA IBD patients, including improved healthcare access, financial and social support, and culturally sensitive educational initiatives.