Our understanding of bile metabolism and the molecular effects of bile acids has expanded in recent years. Bile acids, which are classically recognized for their involvement in dietary lipid absorption, are now known to be involved in many aspects of energy metabolism and disease processes in humans. Cholelithiasis, a consequence of altered bile metabolism, affects a significant number of American adults. An understanding of the disease process, risk factors, and complications of gallbladder disease is necessary for the development of novel targeted treatments and prophylactic therapies against the development of gallstones.