TNF and Achalasia: In our view, the mechanism by which inflammation may increase RDW in patients with achalasia is through ineffective erythropoiesis mediated by cytokines, as has been demonstrated in the pathophysiology of other diseases where tumor necrosis factor alpha (TNF-α), interleukin (IL)-1β, IL-6, interferon gamma (IFN-γ), IL-17, and IL-22 impair erythrocyte maturation.