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Background and Aims: To investigate gender, racial, ethnic, and regional disparities in first and senior authorship positions in gastroenterology/hepatology-related randomised controlled trials (RCT). Method: Retrospective bibliometric analysis of PubMed-indexed RCTs published between January 2000 to December 2022 in leading journals with an impact factor of at least five. Results: 943 RCTs met our inclusion criteria, providing a participant pool of 301 female (15.96%) and 1,585 male (84.04%) authors from 37 countries (70% high-income countries). Despite a significant increase in the proportion of female authors in first and senior authorship positions between 2000 and 2022 (p<0.001), females were grossly underrepresented in both authorship positions, with a male-to-female ratio of 4.45 and 6.37, respectively. The male-to-female ratio was highest among Asian authors (7.79) than among White (4.22), Hispanic (1.44), and Black (1) authors in the first authorship position. In contrast, the male-to-female ratio was similar for Asian (6.2) and White (6.67) authors in the senior authorship position, with a low underlying frequency of Hispanic and Black female authors. Conclusion: Despite significant improvements in gender, racial and ethnic representation in first and senior authorship of gastroenterology/hepatology-related RCTs published in high-impact journals, progress toward parity remains slow. Targeted interventions to improve author diversity are warranted. [ABSTRACT FROM AUTHOR]