Red Blood Cell Distribution Width (RDW) Is a Potential Surrogate Biomarker of Inflammation in Patients With Achalasia: A Cohort Study

Background Current studies demonstrate that red blood cell distribution width (RDW) is a potential surrogate biomarker of inflammation. This study aims to compare the RDW and RDW/lymphocytes ratio in patients with achalasia who underwent five-year postoperative follow-up with those in the gastroesophageal reflux disease (GERD) and healthy donor groups, and to evaluate their clinical relevance in relation to integrated relaxation pressure (IRP), sex, inflammation and the type of achalasia (fibrosis). Materials and methods This was a retrospective study with a five-year follow-up. One hundred sixty-one patients with achalasia, 161 patients with GERD and 500 healthy donors (HD) were included and followed up for five years. The achalasia and GERD patient groups were matched with the HD control group based on demographic characteristics and laboratory variables. The diagnoses of achalasia and GERD were made using high-resolution esophageal manometry, upper gastrointestinal endoscopy, barium esophagography, and 24-hour pH monitoring. For the achalasia group, the correlation between RDW and clinical characteristics, including Eckardt score, Eat Assessment Tool (EAT-10) score, the GERD-Related Quality of Life (GERD-HRQL) questionnaire score, achalasia type, sex, comorbidities, and integrated relaxation pressure, was evaluated using logistic regression analysis. Results The RDW values at baseline differed significantly between patients (achalasia and those with GERD) and HD (<i>P</i><0.001). During follow-up, the achalasia group had substantially higher RDW values ​​than the GERD group (<i>P</i>=0.031). Patients with achalasia experienced a sustained increase in RDW during follow-up compared to their baseline values (All: <i>P</i>=0.010; type I: <i>P</i>=0.006; type II: <i>P</i><0.001; females: <i>P</i>=0.003; males: <i>P</i>=0.948). Conclusion These results underscore the significance of RDW as an inflammatory marker, demonstrating notable temporal variation depending on sex and type of achalasia. This finding contrasts sharply with the stability of the RDW observed in patients with GERD.