Research objective: identification of the nature of liver damage in residents of endemic territory with a chronic phase of opisthorchiasis. In 273 patients with chronic phase of opisthorchiasis, by the absence of markers of viral, autoimmune hepatitis and aggravating factors (drug and alcoholic nature) and duration of invasion for at least five years, there were revealed pronounced pathomorphological changes of cytolytic syndrome (40,3%) to liver fibrosis (2,6 %) and carcinogenesis (1,1%). The nature of the pathology (according to ultrasound, computed tomography, liver biopsy) indicated the development of steatosis and steatohepatitis (in 42,9% and 8,8% of cases observed, respectively) with hepatomegaly (57,5%) and disorders of pigment metabolism in 19,4% of patients. In 15,7%, hyperbilirubinemia with predominance of the indirect fraction was a manifestation of Gilbert’s syndrome. The presented data should be taken into account when conducting differential diagnosis, etiological interpretation of liver pathology in the group of unspecified hepatitis and cirrhosis for timely diagnosis of opisthorchiasis, complete dehelminthization and prevention of development of adverse outcomes in such patients.