Comparative Analysis of Biochemical Markers in Differentiating Gallstone from Non-Gallstone Acute Pancreatitis: A Prospective Observational Study

Background: Acute pancreatitis (AP) is a common gastrointestinal emergency with variable severity and etiology. Rapid differentiation between gallstone and non-gallstone pancreatitis is crucial for guiding targeted therapeutic decisions, such as urgent endoscopic retrograde cholangiopancreatography (ERCP) and same-admission cholecystectomy. The aim and objective are to evaluate the clinical utility of traditional and emerging biochemical markers in diagnosing acute pancreatitis. To establish biochemical cut-offs to differentiate gallstone-induced pancreatitis from non-gallstone etiologies. Material and Methods: A prospective observational study was conducted in the Department of General Surgery, GMKMC Hospital, Salem, over a 2-year period (January 2023 to January 2025). Fifty patients with clinically proven acute pancreatitis meeting the Revised Atlanta Criteria were included. Baseline demographics, clinical parameters, liver function tests (ALT, AST, ALP, bilirubin), pancreatic enzymes (amylase, lipase), and C-reactive protein (CRP) were analyzed. CECT, MRCP, and therapeutic ERCP were utilized as indicated. Results: Out of 50 patients, 28 (56%) were diagnosed with gallstone pancreatitis and 22 (44%) with non-gallstone pancreatitis. Female gender was significantly associated with gallstone etiology (85.7% vs. 14.3% in males, p < 0.001), whereas male gender and alcohol consumption were strongly associated with non-gallstone etiology (59.1% alcohol use, p < 0.05). Liver transaminases and cholestatic markers showed statistically significant elevations in the gallstone group: ALT (164.99 ± 44.11 vs. 122.15 ± 41.54 U/L, p = 0.0010), AST (137.79 ± 31.69 vs. 90.71 ± 17.82 U/L, p < 0.001), ALP (262.13 ± 26.35 vs. 226.71 ± 57.44 U/L, p = 0.0122), and Total Bilirubin (1.99 ± 0.74 vs. 0.70 ± 0.61 mg/dL, p < 0.001). Serum amylase, lipase, and CRP levels showed no significant intergroup differences. Among 10 patients with choledocholithiasis undergoing ERCP, successful cannulation in 8 (80%) resulted in significant post-procedure reductions in serum amylase and lipase (p < 0.05). Conclusion: Early measurement of hepatobiliary enzymes specifically ALT, AST, ALP, and total bilirubin reliably differentiates gallstone from non-gallstone acute pancreatitis at presentation. Female gender is strongly associated with gallstone etiology, while male sex and alcohol abuse correlate with non-gallstone acute pancreatitis. Integrating early biochemical profiling with selective imaging optimizes management pathways and patient outcomes.

Keywords: Acute pancreatitis, gallstone pancreatitis, alanine aminotransferase (ALT), bilirubin, biomarkers, choledocholithiasis, ERCP.