From the Guidelines

Yes, aspiration from Gastroesophageal Reflux Disease (GERD) can ultimately result in obstructive and restrictive lung disease.

GERD has been linked to various extraesophageal manifestations, including cough, laryngeal hoarseness, dysphonia, pulmonary fibrosis, and asthma 1.
Aspiration of gastric contents can cause chronic inflammation and fibrosis in the lungs, leading to conditions such as bronchiectasis and idiopathic pulmonary fibrosis (IPF) 1.
The presence of abnormal acid gastroesophageal reflux (GER) is a risk factor for aspiration, which can contribute to chronic airways inflammation and fibrosis 1.
Medical and surgical management of gastroesophageal reflux has been shown to stabilize pulmonary function and oxygen requirements in patients with IPF 1.

Diagnostic algorithms for extraesophageal reflux (EER) are difficult due to the heterogeneous and overlapping nature of its manifestations 1.
Laboratory tests such as esophageal manometry, barium esophagography, and 24-h esophageal pH monitoring can be used to assess for GER events and their potential to cause laryngopharyngeal injury and aspiration 1.
The sensitivity and specificity of these tests in assessing aspiration in bronchiectatic patients have not been investigated, and the method of evaluation should be tailored according to clinical features 1.

From the Research

Aspiration from GERD has been associated with a range of respiratory disorders, including asthma, chronic obstructive pulmonary disease (COPD), and idiopathic pulmonary fibrosis 2.
Studies have suggested that proximal oesophageal reflux may lead to microaspiration, which could play a causal role in respiratory disease 2.
A bidirectional two-sample Mendelian randomization study found a causal relationship between GERD and COPD, with GERD increasing the risk of COPD and vice versa 3.

Decreased lower and upper esophageal sphincter pressures, esophageal dysmotility, and high transdiaphragmatic pressure have been implicated in the development of GERD in COPD patients 4.
Aspiration of regurgitation and the cholinergic-mediated esophagobronchial reflex are thought to play a significant role in the pathophysiology of GERD in COPD 4.
Impaired esophageal and gastric motility may indirectly contribute to the aspiration process and exacerbate GERD 5.

Chronic occult aspiration has been associated with a high prevalence of GERD, esophageal dysfunction, and other comorbid conditions 6.
Radiologic patterns of chronic occult aspiration include multilobar centrilobular nodularity, tree-in-bud, and airway thickening, with some patients showing evidence of fibrosis 6.
Pathologic findings include exogenous lipoid pneumonia, poorly formed granulomas, and foreign body-type multinucleated giant cells with or without foreign material 6.

Acid inhibitory agents and prokinetic agents are commonly used to treat GERD in COPD patients 4.
Endoscopic fundoplication may be performed in patients with GERD refractory to medical treatment 4.
Early diagnosis and treatment of GERD are crucial in the management of COPD, as GERD can worsen symptoms, quality of life, and lung function 4.