This paper reviews the pathogenic mechanisms of the development and progression of comorbid cholelithiasis (CL) and non-alcoholic fatty liver disease (NAFLD). The authors discuss gender and anatomic physiological patterns, and the effects of insulin resistance, obesity, adipose tissue hormones, and cholecystectomy on clinical morphological abnormalities in coexisting CL and NAFLD. In addition to lipid metabolism abnormalities, comorbid CL and NAFLD are characterized by deviations in the amount and proportions of fatty acids and hormonal imbalance (i.e., hyperleptinemia, leptin resistance, and insulin resistance). Cholecystectomy is an unfavorable factor for the progressive course of NAFLD and development of liver fibrosis. As a result, individualized management strategies are required in these cases. The authors present their own study that enrolled 183 patients with NAFLD. Their data demonstrate that coexisting NAFLD and CL have certain clinical laboratory signatures, while the postoperative period after cholecystectomy in patients with NAFLD is characterized by greater cardiovascular risk and liver fibrosis progression. The authors discuss the use of a combined preparation of ursodeoxycholic acid and sodium glycyrrhizinate in these patients. Two-component hepatoprotective treatment with this agent has pathogenically-target effect in comorbid NAFLD and CL. KEYWORDS: non-alcoholic fatty liver disease, cholelithiasis, comorbidity, liver fibrosis, cholecystectomy. FOR CITATION: Krolevets T.S., Livzan M.A., Syrovenko M.I., Cherkashchenko N.A. Pathogenic aspects of the comorbid course of non- alcoholic fatty liver disease and cholelithiasis: a review and the authors’ results. Russian Medical Inquiry. 2022;6(5):278–285 (in Russ.). DOI: 10.32364/2587-6821-2022-6-5-278-285.