BACKGROUND: As rates of inflammatory bowel disease (IBD) rise among non-English speaking populations, it is imperative to better understand the impact of language barriers and cultural differences on disease management. METHODS: Multi-center, retrospective, cohort study of adult patients with IBD who spoke a language other than English, matched 1:2 to English-speaking controls. Patients were enrolled at their first clinic visit and then followed up to 12 months. Advanced therapy (AT) was defined as a biologic or small molecule. Primary outcome was the rate of AT use between cohorts. Secondary outcomes included rates of AT initiation and corticosteroid-free clinical remission at 6 and 12 months. RESULTS: 144 patients with IBD (48 non-English speakers, 96 English speakers) were included in this study. Both cohorts had similar baseline disease activity based on physician global assessment, however non-English-speaking patients had significantly higher rates of baseline elevated fecal calprotectin (91.7% vs 50%, P=0.014). After multivariate analysis to adjust for baseline differences, we found no difference in prior or current advanced therapy use. Rates of initiation of advanced therapy were similar between the two groups at 6- and 12-month follow up. Adjusted rates of corticosteroid-free clinical remission were not different at 6 and 12 months. CONCLUSIONS: Primary language spoken did not significantly impact the rates of advanced therapy use or overall IBD disease activity in two academic practices. Future studies are warranted to understand the effect of language on medication adherence, patient satisfaction and understanding, and disease outcomes.