The possible association of pancreatitis with primary sclerosing cholangitis was studied in 17 patients. At endoscopic retrograde cholangiopancreatography (ERCP) four patients (24%) were found to have pancreatic changes in addition. The secretin test was abnormal in one patient, who also had morphological signs of pancreatitis at ERCP. One patient had raised basal serum concentrations of amylase and lipase, and another had decreased pancreatic amylase; these two patients had normal findings on ERCP and normal secretin tests. The findings suggest that pancreatic changes are present in a proportion of patients with primary sclerosing cholangitis despite the lack of clinical suspicion of pancreatitis. The pancreatic damage, however, seems to be confined to alterations in ductal morphology rather than including functional impairment.