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Background: Acute pancreatitis may cause diabetes and impaired exocrine function, but especially after single episode of pancreatitis the possible changes in pancreatic function are poorly documented. A cohort of patients with acute alcohol pancreatitis (Gastroenterology 2009;136:848-55.) were further followed for their pancreatic function.Methods: Patients were followed up to 7 yrs. Patients were interviewed for possible recurrent acute pancreatitis and fecal elastase tests and tests for glucose metabolism were performed.Results: 49 out of the initial 119 patients were still continuing in the follow-up program March 2010. 33/119 patients (28%) had developed a recurrent pancreatitis. 7 patients (6%) had diabetes already prior to the first episode of acute pancreatitis. New onset diabetes was observed in 26 patients and tended to be more common in patients with recurrent attacks, compared to the patients with a single episode of acute pancreatitis (44% vs. 23%; p=0.06). Also the number of patients with impaired glucose metabolism increased throughout the follow up. In patients without recurrent pancreatitis, the mean fecal elastase activity increased up to 3 yrs and then slowly decreased. The proportion of patients (6%) with abnormally low elastase values (< 100 ug/g) was at its lowest 3 yrs after the single episode of acute pancreatitis. In patients without recurrent pancreatitis, 23% of those who developed diabetes, also developed exocrine pancreatic insufficiency and 60% of those with low elastase activity also had diabetes. The pancreatic function during the follow up did not correlate with the severity of the initial pancreatitis.Conclusions: The risk for new onset diabetes increases during the follow up also after a single episode of acute alcoholic pancreatitis. Pancreatic exocrine function first improves for the 2 - 3 yrs after a single episode of acute pancreatitis, and impairs only thereafter. Most of the patients who develop exocrine insufficiency also have diabetes. These results indicate that even a single episode of acute alcoholic pancreatitis leads to endocrine and exocrine insufficiency of the pancreas during the following years.