Gallstones are a common and frequently occurring digestive disease with cholesterol stones being the most prevalent type. Intestinal flora gallbladder function environment genetics and cholesterol metabolism are just a few of the factors that play a role in the mechanism of cholesterol stones at this time. Clinical research on how to prevent and treat cholesterol stones has become a hot topic and challenge. According to some studies hydrophilic bile acid drugs can help prevent and treat some gallstones proving that bile acid is a key factor in the formation of gallstones. It is not only a crucial component of bile that aids in the breakdown and absorption of human lipids but it is also one of the cholesterol's metabolites. The stability of cholesterol in bile must be maintained in order to avoid cholesterol stones from developing. In bile cholesterol phospholipid bile acid and other organic components typically remain in a reasonable ratio preventing cholesterol crystals from easily depositing and forming stones. However when bile acid synthesis secretion transport uptake and reabsorption are abnormal bile acid pool will be reduced bile homeostasis is unbalanced and cholesterol oversaturation will precipitate and cause stone formation. In addition bile acid metabolism problems will worsen gallbladder problems alter intestinal flora and hasten the development of cholesterol stones. This paper reviews the relationship between bile acid metabolism and the pathogenesis of cholesterol stones and the most recent advances in research in order to better understand the internal relationship between the aforementioned mechanisms.