Mechanistic and therapeutic advances in immune-mediated gastrointestinal disorders

This review examines recent developments in immune-mediated gastrointestinal (GI) disorders, focusing on the immunopathogenesis and evolving therapeutic landscapes of conditions such as autoimmune enteropathy, autoimmune gastritis, achalasia, celiac disease, inflammatory bowel disease, GI sarcoidosis, GI vasculitis, and eosinophilic GI disorders, among others. We explore new insights into the mechanisms underpinning the dysregulated immune responses that fuel these disorders, influenced by genetic factors and environmental insults, including dysbiosis. The review highlights the roles of key immune components, fibrosis, and gut microbial changes in disease pathogenesis, as identified using immunologic, histopathologic, omics, and microbiome studies, and discusses novel therapeutic strategies potentially capable of improving patient outcomes. Despite significant progress, several challenges in the effective management of these conditions remain, underscoring the need for continued research to develop targeted, disease-modifying therapies that do not compromise normal immunity.