Summary. Aim. To evaluate the features of acute alimentary pancreatitis and the risk of complications in patients with a combination of PRSS1 and SPINKI1 gene mutations. Materials and methods. 70 patients with acute alimentary pancreatitis were examined. The mean age was 45.4±13.87 years. The study group included 48 (68.57 %) men and 22 (31.43 %) women. In 34 (48.57 %) patients there was a severe course of acute pancreatitis, in 25 (35.72 %) – moderate severity, in 11 (15.71 %) – mild. Complicated disease was diagnosed in 59 (84.29 %) patients, 11 (15.71 %) – uncomplicated. The severity of the course and the presence of complications were evaluated using the Atlanta Classification, 2012. The polymorphism of the PRSS1 and SPINKI1 genes was determined by all subjects. Statistica 13 was used for statistical analysis. Results and discussion. The combined effect of the PRSS1 and SPINKI1 gene mutation is associated with a higher risk of severe alimentary pancreatitis. The presence of a combined mutational status increases the chances of developing peritonitis, pleurisy, pancreatic accumulation, pseudocysts and pancreatogenic diabetes mellitus. In addition, these patients have proven significantly higher chances of formation of purulent peritonitis, phlegmon, suppuration of pseudocysts, development of systemic complications – systemic inflammatory response syndrome and multiple organ failure syndrome. Conclusions. The reliable connection between the presence of a combination of mutations of the studied genes and the development of severe course of acute alimentary pancreatitis and the formation of complications have been proved.