Whether acute alcoholic pancreatitis may occur without underlying alcoholic chronic pancreatitis is still a matter of debate. The aims of this study were to assess the frequency and delay of signs of alcoholic chronic pancreatitis in patients who had an alcoholic acute pancreatitis revealing a pancreatic disease. From 1975 to 1993, all patients hospitalised for acute alcoholic pancreatitis as a first manifestation for a pancreatic disease and with follow-up > 2 years were included. Definite (pancreatic calcifications, mild to severe Wirsung duct abnormalities, histological or operative data) and probable (diabetes mellitus) diagnosis of chronic alcoholic pancreatitis was systematically searched for initially and during follow-up. Among 122 patients, 114 were included and 8 were excluded because of insufficient follow-up. A definite diagnosis of chronic pancreatitis was made in 101 patients (88.6%) (pancreatic calcifications: n = 71, mild to severe pancreatographic abnormalities: n = 19, histological data: n = 8, peroperative data: n = 3). In 61 patients, the diagnosis of chronic pancreatitis was made during the first year of follow-up and in 40 patients, the diagnosis was made after one year of follow-up. Diabetes mellitus occurred in 4 other patients (3.5%) in whom diagnosis of chronic pancreatitis was considered as probable. No signs of chronic pancreatitis were found in 9 patients (7.9%). Acute alcoholic pancreatitis is the hallmark of underlying chronic pancreatitis in 92.1% of patients. Acute alcoholic pancreatitis without underlying chronic pancreatitis either does not exist or is extremely rare.