Significant progress has been made to reduce diarrhea burden globally, but climate change threatens these gains. Several reviews have explored historic associations between meteorological factors and diarrheal diseases, but none have evaluated the literature on projections of future trends. We summarize climate change-attributable projections of diarrheal diseases, appraise study methods and results, and examine evidence for adaptation strategies. We searched Web of Science and PubMed databases for terms related to diarrhea, dysentery, and projected climate change through February 2024 and included studies with future projections of climate-related diarrhea burden. We summarized range of projected percent change in future diarrheal disease relative to study baseline, stratified by economic context, pathogen, time period, and emission scenario. We assessed modeling approaches and quality of evidence for included studies. We screened 2949 records, reviewed full text for 105, and ultimately included 35. There was substantial heterogeneity in study approaches, for example types of models implemented, exposure and outcomes considered, covariates included, and adaptation or vulnerability scenarios examined. The majority of studies indicated an increase in future diarrheal diseases in the near (2020–40), mid (2040–2060) and long term (2060+) due to climate change, despite overall downward trends in diarrhea rates globally. There was substantial heterogeneity in study approaches. High baseline burdens translated to large increases, even under conservative assumptions about temperature sensitivities and emissions. Projected increases by percent change from baseline were greatest in high-income countries and low-and middle-income countries, and increased in size with increasing severity of emissions scenarios modeled. There were no studies in LICs. Viral pathogen estimates tended to decrease in a warming climate while bacterial pathogens estimates tended to increase. Most studies included multiple emissions scenarios and accounted for future population change, but few incorporated adaptation strategies or changes in underlying population vulnerability. When stratified, studies that considered future adaptation and vulnerability estimated higher projections of future burden compared to studies that did not. Climate change has the potential to increase diarrhea burden, absent adaptation. Diarrhea is heavily dependent on the underlying development context, so explicit inclusion of assumptions on future development factors, including population exposure, vulnerability, and adaptation, is essential for projections of climate-related diarrhea burden. Scenarios such as the shared socioeconomic pathways can help align projections by standardizing modeling approaches and offering future population and economic storylines to be paired with emissions scenarios.