Significance of red blood cell distribution width in children with celiac disease

Background: In adult studies, red blood cell distribution width (RDW) has been suggested to be a predictor of small intestinal atrophy in celiac disease (CD). Our goal is to assess whether RDW can similarly be used as a reliable marker of compliance and predictor of atrophy in pediatric patients with CD. Methods: We performed a retrospective study of children aged 1–17 years old diagnosed with CD from 2008–2018. We reviewed patient demographics, laboratory parameters prior to CD diagnosis, laboratory findings after management with gluten free diet, and histologic findings at the time of diagnosis. Results: Overall, 128 patients met inclusion criteria. No significant difference in RDW was found prior to diagnosis versus after treatment (13.3 vs . 13.1, P=0.590). In addition, RDW did not show clinical significance in detecting villous atrophy (13.4 vs . 13.2, P=0.113). However, further analysis revealed a statistically significant association among patients having a RDW >12.9 and presence of atrophy (P=0.04). Conclusions: There is a clear disparity between adult studies and pediatric studies in the usefulness in RDW as a predictive marker for intestinal atrophy and compliance in patients with CD, as RDW did not show clinical significance in detecting villous atrophy or compliance with a gluten free diet.