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Context It is generally assumed that pancreatic function recovers completely after mild but not after severe acute pancreatitis. Objective To evaluate both pancreatic function and quality of life in patients who had recovered from acute pancreatitis in a long-term follow-up study. Participants Thirty-four patients (mean age: 56 years) who had recovered from biliary (n=26) or post ERCP (n=8) acute pancreatitis. The mean time after the event was 4.6 years. Main outcome measures Pancreatic function was evaluated by fecal fat excretion, urinary 4-aminobenzoic acid (PABA) recovery, oral glucose tolerance test and pancreatic polypeptide (PP) secretion. In addition, the quality of life was measured by the gastrointestinal quality of life index (GIQLI). Results Of the 34 patients, 22 (65%) had mild and 12 (35%) had severe acute pancreatitis. Exocrine insufficiency (fecal fat greater than 7 g/24h and/or urinary PABA recovery less than 50%) was present in 22 (65%) patients: in 10 (83%) after severe and in 12 (55%) after mild acute pancreatitis, respectively (P=0.140). Endocrine insufficiency was present in 12 patients (35%): 7 (32%) mild versus 5 (42%) severe acute pancreatitis; P=0.711. the quality of life was significantly impaired after acute pancreatitis, (P=0.024). No significant relationship was found between the severity of the pancreatitis and impairment of the quality of life (P=0.604). Conclusion In a significant proportion of patients who had recovered from acute pancreatitis, exocrine and endocrine functional impairment was found. This finding is not confined only to patients after severe acute pancreatitis. Routine evaluation of pancreatic function after acute pancreatitis should be considered.