Gastrointestinal-related aspiration in cystic fibrosis (GRASP-CF)

The concept of gastroesophageal reflux (GER), aspiration, and swallowing dysfunction in cystic fibrosis (GRASP-CF) extends beyond GER to include esophageal dysmotility, impaired transit, and delayed gastric emptying as contributors to aspiration risk and pulmonary injury. Foregut dysfunction is common in people with cystic fibrosis and has been associated with accelerated lung function decline, increased pulmonary exacerbations, and worse post-lung transplant outcomes. Current diagnostic and therapeutic approaches remain centered on gastroesophageal reflux disease, relying on distal esophageal metrics that do not adequately capture proximal reflux or aspiration risk. The absence of validated diagnostic criteria and relevant physiological parameters limits accurate identification of GRASP-CF. In addition, standard treatments such as proton pump inhibitors may not reduce reflux burden and could have unintended adverse effects. Alternative strategies targeting reflux frequency, esophageal motility, and gastric emptying, as well as surgical interventions, show variable benefit. Future research priorities include establishing reliable biomarkers for GRASP-CF, establishment of physiologically relevant diagnostic thresholds, and evaluating targeted interventions in prospective studies. A structured, multidisciplinary approach incorporating objective assessment of both deglutitive and retrograde aspiration is essential to improve pulmonary outcomes and guide more effective, mechanism-based management strategies in people with cystic fibrosis.