Biliary aetiology seems related to a number of acute pancreatitis: biliary sludge and dysfunction at the sphincter of Oddi appear to be responsible for most cases pancreatitis previously classified as idiopathic. The presence and extent of necrosis and its overinfection are the two main factors responsible for history and prognosis of acute pancreatitis: CT scan may can correctly recognize them, whereas multiparametric and biohumoral prognosis have lost a lot of their importance. Supportive medical treatment is essential in the early phase of the disease, while antisecretory and antiprotease drugs do not show a clear clinical efficacy. Antibiotics, if active against bacteria usually found in pancreatic infections and able to concentrate in pancreatic tissue, seem to prevent the septic complications of pancreatitis; the role of topical antibiotics and enteral feeding in preventing bacterial translocation needs further evaluation in the future. Early endoscopic treatment is gaining importance for biliary, or suspected biliary, pancreatitis, whereas in selected cases percutaneous drainage is able to deal with septic complications. Surgery remains an effective when infected necrosis are detected and in cases of extended sterile necrosis with organ failure.