The growing consumers' request for foods with well-balanced nutritional profile and functional properties promotes research on innovation in pasta making. As a staple food and a common component of diet, pasta can be considered as a vector of dietary fiber, vegetable proteins, vitamins, minerals, and functional compounds. The conventional process for pasta production does not include a fermentation step. However, novel recipes including sourdough-fermented ingredients have been recently proposed, aiming at enhancing the nutritional and functional properties of this product and at enriching commercial offerings with products with new sensorial profiles. The use of sourdough for pasta fortification has been investigated under several aspects, including fortification in vitamin B, the reduction of starch digestibility, and gluten content. Sourdough fermentation has also been successfully applied to non-conventional flours, (e.g., from pseudocereals and legumes), in which an overall increase of the nutritional value and health-promoting compounds, such as a significant decrease of antinutritional factors, were observed. Fermented non-conventional flours, obtained through spontaneous fermentation or using selected starters, have been proposed as pasta ingredients. As the result of wheat replacement, modification in textural properties of pasta may occur. Nonetheless, fermentation represents an efficient tool in improving, besides nutritional and functional profile, the sensory and technological features of fortified pasta.