Hyperspectral imaging (HSI) captures the spectral information of tissues in multiple narrow bands to provide the rich biochemical and spatial characteristics for the diagnosis and treatment of gastrointestinal diseases. This review summarizes the technical principles, system components, and data processing methods of HIS. The focus of the article is on its applications in the digestive tract. In esophageal, gastric, and colorectal lesions, HSI can non-invasively detect early cancer and precancerous lesions to improve the diagnostic accuracy. In small intestinal ischemia and intraoperative settings, it can quantitatively assesse the tissue oxygenation and perfusion. There are the challenges of device integration, real-time imaging, and algorithm interpretability. However, HSI is expected to become a key tool for endoscopic " optical biopsy" and precision diagnosis and treatment with the miniaturization of hardware and multimodal integration.