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.