Private equity activity in gastroenterology is slowing in frequency, even as deal sizes and consolidation momentum grow. This shift is redefining the field — and what independent GI groups and ASCs need to anticipate.
1. Deal volume is falling fast
GI PE transactions fell by 50% over 2022 to 2023, from 26 to 13, respectively. This mirrors a broader healthcare slowdown, where overall PE deals dropped 16.2% in 2023.
2. Deals are bigger and more strategic
Though transaction volume has slowed, consolidation is increasingly driven by large platforms such as Southlake, Texas-based GI Alliance, Miami-based Gastro Health and Atlanta-based United Digestive, which continue to expand nationally. Recent activity includes add-on acquisitions of individual sites, as well as recapitalizations such as GI Alliance’s $785 million deal with Apollo Global Management.
3. Mega-deals are reshaping the market
Major consolidations continue to shake up the GI landscape. In early 2025, Optum subsidiary SCA Health acquired Exton, Pa.-based U.S. Digestive Health, which includes more than 250 providers across 40 practice sites and 24 ASCs. The deal drew strong reactions from physicians and executives, with some citing expanded resources and others raising concerns about clinician autonomy.
“Optum’s acquisition of U.S. Digestive Health is important because it’s an example of how companies can quickly consolidate gastroenterology practices and integrate care within a health insurance ecosystem. … Unfortunately, physicians might lose some autonomy during the acquisition,” Benjamin Levy III, MD, gastroenterologist at University of Chicago Medicine, told Becker’s earlier this month.
4. Reimbursement pressure adds urgency
Gastroenterologists’ compensation is under strain — average pay fell 3% from 2023 to 2024, even before adjusting for inflation. This erosion, combined with fewer but larger PE exits, creates both risk and opportunity for practices.
5. Policy and regulatory scrutiny intensify
New legislation in 2025 is adding hurdles to PE-driven GI consolidation. Oregon enacted the nation’s strictest limits on corporate and private equity ownership of medical groups, requiring physicians to retain majority control. Pennsylvania passed a bill expanding the attorney general’s authority to review and block healthcare M&A. With GI among the most PE-consolidated specialties, these moves could directly impact the structure and pace of future gastroenterology transactions.
