We review both the protein secretory and the necrosis fibrosis hypotheses and point out that they may be complementary rather than opposing hypotheses. Few advances have been made in the etiology and diagnosis of chronic pancreatitis, but more evidence shows that pancreas divisum is not a cause of this disorder. Magnetic resonance scanning cannot yet be recommended to detect chronic pancreatitis and noninvasive tests of pancreatic function are useless to detect mild or moderate exocrine insufficiency. The treatment of pain with pancreatic enzymes remains controversial and the claim that endoscopic therapy relieves pain has not been tested in randomized controlled trials. Finally, the treatment of steatorrhea remains a problem and will not be solved until simple, reliable methods to deliver enough lipolytic activity to the duodenum are developed.