The causes of recurrent acute pancreatitis, including the newly recognized genetic causes, are reviewed. The pitfalls of overcalling the diagnosis of pancreatitis in patients with abdominal pain or other symptoms and the role of a careful history are emphasized. The presence of undetectable microlithiasis in patients with unexplained pancreatitis is discussed. The popular notion of pancreas divisum and sphincter of Oddi dysfunction as causes of pancreatitis is challenged, as is the role of endotherapy in these conditions.