The histopathology of advanced chronic alcoholic pancreatitis was dominated by cellular degeneration, atrophy and fibrosis. Sequential changes in the histopathology of alcoholic pancreatic disease were defined and traced from initial injury to end-stage disease. These sequential histopathologies were correlated with clinical syndrome and secretory patterns. Data were more consistent with a toxic-metabolic pathogenesis of alcoholic pancreatitis than the previous Big Duct and Small Duct hypotheses.