<p>The gut microbiota plays a critical role in maintaining human health and is closely associated with the onset and progression of various diseases through its influence on immune regulation, metabolic homeostasis, intestinal barrier integrity, and the nervous system. In recent years, gut microbiota-derived extracellular vesicles(GMEVs) have attracted increasing attention as emerging mediators of host-microbe communication. These nanoscale vesicles possess a lipid bilayer membrane and are capable of encapsulating diverse bioactive molecules such as proteins, lipids, and nucleic acids. As essential mediators of intercellular communication, GMEVs act as molecular messengers that facilitate host–microbiota interactions. GMEVs exhibit high stability, excellent biocompatibility, and low immunogenicity, making them unlikely to trigger adverse immune reactions and thus promising candidates for clinical applications. Their ability to cross biological barriers further underscores their potential as vehicles for targeted drug delivery. This review provides a comprehensive overview of the physiological relevance of the gut microbiota and the biogenesis, molecular composition, and communication mechanisms of GMEVs. Special attention is given to the roles of GMEVs in the pathogenesis of inflammatory bowel disease (IBD), neurological disorders, and metabolic diseases. As ongoing research advances our understanding of the biological properties and disease-specific functions of GMEVs, these vesicles are emerging as novel therapeutic targets and strategic tools in precision medicine. Finally, this review discusses recent progress in GMEVs-based therapeutic strategies, offering new insights and possibilities for the treatment of diverse diseases.</p>