To describe the physiological mechanisms of intestinal fluid and electrolyte transport, their regulation, and implications in digestive diseases. A narrative review of recent physiological and biomedical literature was conducted, focusing on major intestinal transporters and channels (SGLT1, NHE3, DRA, ENaC, CFTR) and their neuroendocrine regulation. Intestinal transport depends on the interplay between active and passive mechanisms regulated by neurohormonal signals. Dysregulation causes disorders such as secretory diarrhea, Crohn’s disease, and short bowel syndrome. In secretory diarrhea, enterotoxins activate CFTR, increasing Cl⁻ and water secretion; in Crohn’s disease, inflammation impairs absorption and barrier integrity; and in short bowel syndrome, resection induces compensatory functional and structural adaptations. Understanding intestinal transport physiology clarifies the pathophysiology of major gastrointestinal diseases and guides effective therapeutic strategies such as oral rehydration, early enteral nutrition, and hormonal modulators.