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Among various types of tissue adhesives, hydrogel adhesives have attracted tremendous attention and have been used in the clinic due to their atraumatic nature, good biocompatibility, and tunable physicochemical properties. Despite their promise, the bioadhesive applications with engineered hydrogels still face challenges in the wet and acidic gastric environment. This review outlines the mainstream design approaches of hydrogel adhesives through covalent and noncovalent molecular interactions, illustrating the underlying adhesive mechanisms and material properties. Representative GI applications of hydrogel adhesives are also summarized. 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