The development of gastric dysplasia and neoplasia in patients with pernicious anaemia has been evaluated in a prospective clinical and endoscopic follow up study. After Because a close association has been described between atrophic gastritis and intestinal metaplasia and the development of gastric carcinoma,' these are now considered to be precancerous lesions.6 In pernicious anaemia, chronic atrophic gastritis with intestinal metaplasia is common, and gastric polyps are frequently found.7 ' -Endoscopic screening of patients with this disorder showed a high incidence of gastric mucosal dysplasia,9'0 and pernicious anaemia is therefore assumed to be a precancerous condition.

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The definition of the orocoecal transit time by means of the hydrogen (H2) breath test is not unequivocal. In this study the orocoecal transit time as measured with an H2 breath test was compared with that obtained with a radiologic method. Two definitions of orocoecal transit time by the H2 breath test were evaluated: the time from eating to the first of three consecutively rising H2 values, and the interval to H2 values 50% above 'small-bowel level'. Transit times measured in accordance with both definitions were closely correlated to that obtained with the radiologic method (A, r = 0.84; B, r = 0.90; for both, p less than 0.001), but transit time measured by definition A gave shorter values than the radiologic method (p less than 0.05). The mean transit time in patients with constipation was significantly longer than that in normal subjects and patients with functional diarrhoea (p less than 0.05). There was a significant correlation between the difference in transit time measured with the H2 breath test and the radiologic method and the transit time measured by the control method. This may indicate that rapid transit is associated with a delayed 'colonic' rise in H2 levels and slow transit with an early H2 rise.

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