Rituximab a chimeric anti-CD20 monoclonal antibody, has transformed the treatment of B-cell malignancies and autoimmune disorders [1, 2]. While its therapeutic efficacy is well-established, developing evidence has revealed a complex and increasingly recognized spectrum of gastrointestinal mucosal injuries associated with its use. This review synthesizes recent literature including landmark 2025 studies, to present a comprehensive overview of rituximab-associated gastrointestinal mucosal injury. We describe clinical presentations, endoscopic findings and histopathologic features across the entire gastrointestinal tract from the esophagus to the colon. A particular focus is placed on the newly characterized rituximab-associated common variable immunodeficiency (CVID)-like enteropathy, a severe and late-onset syndrome characterized by hypogammaglobulinemia, malabsorption and distinctive histologic features [3, 4]. We also discuss the proposed pathogenic mechanisms, clinical approach to diagnosis, management strategies and areas for future research.