Association of Gallstone-Induced Pancreatitis with Gallstone Characteristics

Association of Gallstone-Induced Pancreatitis with Gallstone

Abstract

Background: Gallstone disease is among the most prevalent hepatobiliary disorders worldwide and represents a leading etiology of acute pancreatitis. While gallstones are a well-established cause of pancreatitis, the precise influence of gallstone characteristics particularly size and number on the occurrence and severity of gallstone-induced pancreatitis remains incompletely defined. This study aimed to evaluate the association between gallstone characteristics and gallstone induced pancreatitis, and to compare these findings between patients with and without pancreatitis. Subjects and Methods: A hospital-based observational analytical study was conducted at the Department of General Surgery, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, India. A total of 184 participants were enrolled: 92 patients with gallstone-induced pancreatitis (cases) and 92 patients with symptomatic gallstone disease without pancreatitis (controls). Gallstone size and number were assessed by abdominal ultrasonography. Diagnosis of acute pancreatitis was established using the Revised Atlanta Classification. Statistical associations were determined using Chi-square test and multivariate logistic regression analysis. Results: A female predominance was noted in both groups. Mean gallstone size was significantly larger in cases than controls (12.6 ± 5.2 mm vs. 5.8 ± 2.4 mm; p<0.001). Gallstone number alone was not significantly associated with pancreatitis (p=0.89); however, the combined effect of stone size and multiplicity demonstrated a highly significant association (p<0.001). Multivariate logistic regression identified gallstone size ≤5 mm (Adjusted OR=4.82; p<0.001) and multiple stones (Adjusted OR=2.96; p=0.001) as independent predictors of pancreatitis. Mild pancreatitis was the most common presentation (63.0%), followed by moderately severe (26.1%) and severe (10.9%). Larger stones and stone multiplicity were significantly associated with greater disease severity and higher serum amylase levels (p<0.001). Conclusion: Gallstone size and multiplicity are important independent predictors of both the occurrence and severity of gallstone-induced pancreatitis. Routine ultrasonographic assessment of these parameters may facilitate risk stratification, guide prophylactic intervention, and help reduce pancreatitis-related morbidity.