From the Guidelines

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

GERD is a known risk factor for aspiration, which can contribute to chronic airways inflammation and fibrosis 1
Aspiration due to GERD has been implicated in the development of pulmonary fibrosis, a restrictive lung disease 1
Recurrent aspiration due to dysphagia or gastro-oesophageal reflux is recognized to cause bronchiectasis, an obstructive lung disease 1
The presence of lipid-laden alveolar macrophages in bronchoalveolar lavage (BAL) fluid or induced sputum can be a marker of aspiration 1
GERD can cause cough, laryngeal hoarseness, dysphonia, and other extraesophageal symptoms, which can be associated with aspiration and lung disease 1

A careful gastrointestinal history focusing on symptoms of reflux and dysphagia should be undertaken in patients with suspected aspiration 1
Investigative modalities such as videofluoroscopic swallow study, upper gastrointestinal endoscopy, ambulatory oesophageal manometry, and pH studies can be used to assess 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

Medical and surgical management of gastroesophageal reflux may be beneficial in stabilizing pulmonary function and oxygen requirements in patients with idiopathic pulmonary fibrosis (IPF) 1
Asymptomatic gastroesophageal reflux disease may be medically treated in patients with IPF to prevent aspiration and potential lung damage 1

From the Research

Aspiration from GERD can lead to various respiratory disorders, including asthma, chronic obstructive pulmonary disease (COPD), and idiopathic pulmonary fibrosis, as suggested by studies 2, 3, 4, 5.
The association between GERD and lung disease is thought to be more than coincidental, with proximal oesophageal reflux potentially playing a causal role in respiratory disease 2.
Microaspiration of gastroduodenal contents is considered a key mechanism by which GERD contributes to lung disease, with impaired esophageal and gastric motility being potential risk factors 6, 4.

Chronic occult aspiration, often associated with GERD, can lead to a spectrum of lung diseases, including obstructive and restrictive patterns, as well as fibrosis 4.
The radiologic presentation of chronic occult aspiration typically includes multilobar centrilobular nodularity, tree-in-bud, and airway thickening, with some patients showing evidence of fibrosis 4.
Antireflux therapy may improve outcomes of some pulmonary complications of GERD, although careful selection of candidates is crucial for successful outcomes 5.

GERD is a common comorbidity in patients with COPD, and its presence is associated with worse symptoms, quality of life, and lung function, as well as a high risk of exacerbations 3.
The diagnosis of GERD in patients with lung disease can be challenging, as typical esophageal symptoms are often absent, and objective assessment with reflux monitoring is frequently needed 5.