The pathogenesis of chronic alcoholic pancreatitis has not been elucidated yet. There are many theories about this topic. The first regards the initial injuries in the ductal pancreatic system. The second considers that the primary lesion is located in the acinar cells. Three hypotheses are elaborated in this respect: the intervention of toxic metabolites, oxidative stress or neuroimmmune system. The third theory sustains that a severe initial attack of acute pancreatitis may induce lesions typical of chronic pancreatitis. Recently the intervention of genetic factors, responsible for the susceptibility chronic pancreatitis has been put forward.