Use of Proton Pump Inhibitor Linked to Risk for Pleural Empyema, Lung Abscess

Chest X-ray of a lung abscess. An abscess is an accumulation of puss within a cavity in tissue. It is usually as a result of an infection or other foreign material
Is the use of proton pump inhibitors associated with empyema and lung abscess? Presenters at CHEST 2022 analyzed a large data base to address this question.

Use of proton pump inhibitors (PPIs) is associated with an increased risk of pleural empyema and lung abscess, according to study results being presented at the American College of Chest Physicians (CHEST) 2022 Annual Meeting, held from October 16 to 19, 2022, in Nashville, Tennessee.

Although increasing reports have indicated that proton pump inhibitors pose serious health risks, data has been lacking with respect to empyema and lung abscess, 2 serious lung infections. Investigators therefore analyzed a large database to determine if proton pump inhibitor use was associated with empyema and lung abscess.

The researchers used the Explorys Inc database, which includes electronic health records of 80,367,130 patients from 26 major US health care systems, to identify 7090 patients (all aged 30 to 85 years) with pleural empyema and lung abscess reported between 2018 and 2021. These patients were then divided into 2 cohorts based on whether or not they had used a PPI.

Researchers found the prevalence for pleural empyema/lung abscess was 0.04% in those who has used PPI and 0.004% in the control group. Univariate analysis showed that patients in the PPI group were statistically more likely to have pleural empyema or lung abscess than those in the control group (odds ratio [OR], 10.5; 95% CI, 10.02-11; P <.001).

The univariate analysis also included such predictors as age, sex, race, malignancy, chemotherapy, alcohol abuse, smoking tobacco, diabetes, gastroesophageal reflux disease, and HIV. The researchers found that in addition to use of PPI, a statistically significant risk of developing pleural empyema or lung abscess was also associated with advanced age, tobacco smoking, HIV, and chemotherapy.

Study limitations include the retrospective design and inability to assess the dose and duration of PPI use.

“Further studies are needed to shed more light on this association,” stated the researchers. “Our study may provide direction to limit use of PPI with no strong indications, particularly in the elderly, patients on chemotherapy, or [those with] HIV.”


Dahabra L, Yassine AA, Assaad M, et al. Proton pump inhibitors and risk of pleural empyema and lung abscess. Abstract presented at: CHEST 2022 Annual Meeting; October 16-19, 2022; Nashville, TN.

This article originally appeared on Pulmonology Advisor