Microlithiasis as a Predictor of Disease Severity in Gallstone-induced Acute Pancreatitis

INTRODUCTION: Gallstones, particularly microlithiasis, constitute the predominant etiology of acute pancreatitis. A minority of people with gallstones experience pancreatitis. The close closeness of the common bile duct (CBD) and the main pancreatic duct, which converge at the hepatopancreatic ampulla of Vater, renders the main pancreatic duct susceptible to obstruction by gallstone impaction. This impaction obstructs the normal flow of pancreatic enzymes, resulting in leakage through the glandular parenchyma and autodigestion of cells, so inducing pancreatitis. A smaller gallstone size (<5 mm) correlates with an increased likelihood of pancreatitis, since it facilitates unimpeded transit down the CBD, resulting in distal obstruction at the ampulla. Serum lipase and alanine transaminase levels are the recognized biochemical indicators of pancreatitis. Aspartate transaminase (AST) is a potential specific marker for gallstone pancreatitis. AIMS: Our study aimed to investigate the clinical profile of gallstone pancreatitis in 50 patients between 15 and 75 years of age, with special attention to the size of gallstones causing the condition. Furthermore, we looked into the biochemical profile of gallstone pancreatitis to evaluate AST as a specific biomarker. METHODS: A prospective observational study was conducted in 50 patients aged 15-75 years diagnosed with gallstone-induced acute pancreatitis at a tertiary care center in Maharshtra, India. Gallstone size was assessed using abdominal ultrasonography, and severity index. Ser aspartate transaminase (AST) levels were analyzed to assess their correlation with disease severity. Statistical analysis was performed using simple linear regression to evaluate the relationship between gallstone size, AST levels, and pancreatitis severity. RESULTS: Smaller gallstone size showed a significant negative correlation with modified Ranson's score, indicating greater disease severity with smaller stones, whereas AST levels did not show a significant correlation. CONCLUSION: Our study revealed the following findings: A smaller size of gallstone is associated with a higher probability of development of pancreatitis; AST levels fail to be significant as a specific marker for gallstone-induced pancreatitis.