European Journal of Cardiovascular Medicine

Acute pancreatitis (AP) is a sudden inflammatory condition of the pancreas that ranges in severity from mild, self-limiting illness to a life-threatening disease with systemic complications. Among the various etiologies, biliary pancreatitis—triggered by gallstones or biliary sludge obstructing the common bile duct—remains one of the most prevalent causes, especially in regions where gallstone disease is endemic [1]. The demographic and clinical characteristics of patients with acute biliary pancreatitis (ABP) are influenced by geographic, dietary, genetic, and socioeconomic factors, making it crucial to study population-specific profiles to improve early diagnosis and targeted management [2].

Gallstones account for approximately 35–60% of AP cases globally, with higher rates observed in females and individuals over 40 years of age [3]. The obstruction of the ampulla of Vater due to gallstones results in pancreatic enzyme activation, leading to autodigestion and inflammation. The resulting clinical presentation can vary widely—from abdominal pain and vomiting to systemic inflammatory response syndrome (SIRS), organ failure, and even mortality in severe cases [4]. It has been observed that early recognition of clinical signs and risk factors plays a key role in preventing complications and improving outcomes [5].

Recent studies have underscored the importance of analyzing regional demographic data in ABP, especially in developing countries, where access to advanced imaging and endoscopic interventions may be limited [6]. Age and gender distributions, as well as comorbid conditions like obesity, diabetes, and dyslipidemia, have been shown to influence not only the incidence of ABP but also its severity and course [7]. Moreover, lifestyle factors such as dieting high-fat diets and sedentary behavior have contributed to an increased prevalence of gallstone disease, particularly among urban populations [8].

Advancements in diagnostic imaging such as contrast-enhanced CT and MRCP have enabled more accurate identification of biliary obstruction and pancreatic inflammation, facilitating timely interventions [9]. However, in resource-constrained settings, the diagnosis often relies on clinical judgment, ultrasound findings, and biochemical markers like serum amylase and lipase. Additionally, understanding clinical parameters such as duration of symptoms, presence of fever, tachycardia, hypotension, and laboratory abnormalities can help stratify patients for intensive care or surgical referral [10].

Given the rising incidence of biliary pancreatitis and its potential for morbidity and mortality, it is essential to evaluate the demographic and clinical trends in specific hospital settings. The present study aims to assess the demographic pattern and clinical profile of patients presenting with acute biliary pancreatitis in our tertiary care center, thereby contributing to more personalized and evidence-based care.

This hospital-based, observational study was conducted in the Department of General Medicine and Gastroenterology over a period of 12 months, following ethical clearance from the Institutional Ethics Committee. A total of 70 patients diagnosed with acute biliary pancreatitis (ABP) were enrolled consecutively based on predefined inclusion and exclusion criteria

Inclusion criteria comprised adult patients aged 18 years and above, admitted with a clinical diagnosis of acute pancreatitis confirmed by at least two of the following three features: (i) abdominal pain characteristic of pancreatitis, (ii) serum amylase or lipase levels greater than three times the upper limit of normal, and (iii) imaging findings suggestive of pancreatitis on ultrasonography or contrast-enhanced computed tomography (CECT). A biliary etiology was confirmed based on ultrasound findings of gallstones, biliary sludge, or dilated bile ducts, with or without elevated liver enzymes.

Patients with alcohol-induced pancreatitis, drug-induced pancreatitis, trauma-related cases, post-ERCP pancreatitis, malignancy-related pancreatitis, or chronic pancreatitis were excluded from the study. Informed written consent was obtained from all participants prior to data collection.

Detailed demographic data including age, gender, and socioeconomic status were recorded. Clinical presentation such as the nature and duration of abdominal pain, associated vomiting, fever, jaundice, abdominal tenderness, and signs of systemic inflammatory response were documented. Laboratory investigations including complete blood count, liver function tests, renal function tests, serum amylase, serum lipase, and C-reactive protein were conducted. Imaging studies, primarily abdominal ultrasonography and CECT abdomen, were utilized to confirm diagnosis and assess disease severity.

Severity of pancreatitis was categorized using the Revised Atlanta Classification, and presence of local or systemic complications was recorded. Management strategies including conservative treatment, need for intensive care, endoscopic retrograde cholangiopancreatography (ERCP), and surgical intervention were also documented.

All data were compiled and statistically analyzed using SPSS software. Descriptive statistics such as mean, standard deviation, frequencies, and percentages were used for continuous and categorical variables, respectively. Chi-square test or Fisher’s exact test was used to assess associations, and a p-value <0.05 was considered statistically significant.

Table 1 illustrates the age distribution of patients with acute biliary pancreatitis in relation to disease severity, classified according to the Revised Atlanta Classification. The majority of patients fell in the 40–60 years age group, with 30 presenting with mild disease, 3 with moderate, and 3 with severe forms. Patients aged 20–40 years predominantly exhibited mild disease with minimal moderate cases and no severe presentations. Notably, severe cases were more frequent in patients aged over 60, suggesting a possible correlation between advanced age and disease severity. The youngest group (<20 years) had only one mild case. Although the differences were not statistically significant (p=0.087), a trend of increasing severity with age is observed.

Table 2 shows the relationship between the severity of acute biliary pancreatitis and patient outcomes. All patients with mild and moderate disease had favorable outcomes and were discharged after recovery. In contrast, among the six patients classified as having severe disease, two succumbed to complications, resulting in a significant statistical association between disease severity and mortality (p=0.000). This clearly emphasizes the prognostic value of the Atlanta classification in predicting outcomes.

Table 3 highlights the distribution of clinical outcomes across various age groups. All patients below 60 years of age had favorable outcomes, with no recorded deaths. However, two patients aged over 60 expired during the course of treatment, accounting for the study's entire mortality. This observation indicates that increasing age may be a contributing factor to poor prognosis in patients with acute biliary pancreatitis, and the association was found to be statistically significant (p=0.031).

Table 4 examines the relationship between the duration of illness at presentation and patient outcomes. Most patients presented within the first three days of symptom onset, and these groups experienced favorable outcomes. Only two deaths were recorded—one each among those presenting on day 1 and day 2. While early presentation generally appeared to correlate with better recovery, the association between illness duration and outcome was not statistically significant (p=0.712), possibly due to the low number of expired cases.

Table 1: Age distribution and severity of patients with acute biliary pancreatitis

Table 2: Severity of disease and outcome

Table 3: Age distribution and outcome of patients

Table 4: Relation between duration of illness and outcome

This study provides insights into the demographic and clinical profile of patients diagnosed with acute biliary pancreatitis (ABP), emphasizing the significance of age, severity of disease, clinical outcomes, and timing of hospital presentation. The predominance of cases in the 40–60 years age group seen in this study is consistent with recent findings by Rao et al., who noted that gallstone-related pancreatitis tends to peak in the middle-aged population, particularly among females due to hormonal and metabolic risk factors [11]. The minimal incidence of ABP in those below 20 years of age underscores the rarity of gallstone disease in the pediatric and adolescent populations.

Severity-wise, the majority of our cases were classified as mild, with only a small proportion falling into the severe category. This mirrors the trend reported by Lin et al., where 75–80% of biliary pancreatitis cases were self-limiting and recovered with conservative management, while only a minority developed necrosis or systemic complications [12]. In our cohort, all patients with mild and moderate disease had favorable outcomes, while two mortalities occurred among those with severe disease, reinforcing the utility of the Revised Atlanta Classification in anticipating prognosis. Similarly, a multicenter study by Alvarez et al. demonstrated that mortality in ABP was almost exclusively seen in patients presenting with persistent organ failure and systemic inflammatory response syndrome (SIRS), especially among the elderly [13].

The statistically significant association between age and outcome observed in our study supports the growing recognition of age as an independent risk factor in pancreatitis prognosis. As documented by Othman et al., patients over the age of 60 had higher rates of complications, ICU admissions, and mortality, likely due to reduced physiological reserve and higher prevalence of comorbidities [14]. These findings highlight the importance of early aggressive management and close monitoring in elderly patients with ABP.

Our data also evaluated the impact of symptom duration before hospital presentation. Although no significant association was observed between delay in presentation and outcome, most of the expired cases presented early, suggesting that early arrival does not necessarily equate to better prognosis in patients who already have severe disease at onset. However, other studies, such as the work of Wang and colleagues, advocate for prompt admission and early fluid resuscitation in improving survival in ABP, especially before irreversible organ dysfunction sets in [15]. This discrepancy may be attributed to the small number of mortality cases in our sample, limiting the statistical power.

Overall, our study reinforces established patterns in acute biliary pancreatitis while providing locally relevant data that support the predictive value of severity classifications and demographic factors. It also raises the need for timely diagnosis, supportive care, and stratified risk assessment, especially in older adults

The present study highlights that acute biliary pancreatitis is most commonly seen in the middle-aged population, with a clear trend of increasing disease severity and mortality in patients above 60 years of age. Most cases presented with mild forms and had favorable outcomes, while severe disease was strongly associated with mortality. The Revised Atlanta Classification proved valuable in predicting clinical outcomes. Although early presentation is often encouraged, the prognosis appears more closely linked to initial disease severity than timing of admission. These findings underscore the need for early identification of high-risk individuals and the adoption of severity-based management protocols to improve patient outcomes.

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