Objective To systematically review the mechanisms of the gut microbiota-bile acid axis in chronic liver disease and related targeted therapeutic strategies, providing a theoretical basis for the diagnosis and treatment of chronic liver disease. MethodsRelevant domestic and international literature on bile acid synthesis and metabolism, key receptor signaling pathways, gut microbiota-bile acid interactions and its relationships with chronic liver disease were retrieved and reviewed. ResultsBile acids regulate glucose and lipid metabolism, energy homeostasis, immune and inflammatory responses, and intestinal barrier function by activating receptors such as farnesoid X receptor (FXR) and takeda G protein-coupled receptor 5 (TGR5). Gut microbiota participates in bile acid metabolic transformation through deconjugation, dehydroxylation and epimerization reaction, and the two form the gut microbiota-bile acid axis. Dysregulation of this axis can disrupt bile acid metabolism and is closely associated with the development of chronic liver diseases. Therapeutic strategies targeting the gut microbiota-bile acid axis include FXR agonists, TGR5 agonists, bile acid derivatives and gut microbiota modulation. ConclusionsBile acids are important signaling molecules in the gut-liver axis and participate in regulating the pathological processes of chronic liver disease through FXR, TGR5, and their downstream pathways. Targeting metabolic transformations and receptor signaling pathways related to the gut microbiota-bile acid axis has considerable translational potential.