{"id":2886,"date":"2018-10-17T19:08:05","date_gmt":"2018-10-17T17:08:05","guid":{"rendered":"https:\/\/choosingwiselyitaly.org\/raccomandazione-prof\/dont-use-bevacizumab-for-its-various-oncologic-indications\/"},"modified":"2026-01-29T17:43:40","modified_gmt":"2026-01-29T16:43:40","slug":"dont-use-bevacizumab-for-its-various-oncologic-indications","status":"publish","type":"raccomandazione-prof","link":"https:\/\/choosingwiselyitaly.org\/en\/raccomandazione-prof\/dont-use-bevacizumab-for-its-various-oncologic-indications\/","title":{"rendered":"Do not continue proton pump inhibitor (PPI) therapy chronically beyond the indications specified in the product label (e.g., 4\u20138 weeks for the treatment of gastroesophageal reflux disease); instead, reduce the dose (for example, from twice daily to once daily) or discontinue the PPI and use it on an as-needed basis."},"content":{"rendered":"<div>Proton pump inhibitors (PPIs) should be used for the shortest duration possible, as long-term use (over 4\u20138 weeks) has been associated with increased risks of: deficiencies in essential nutrients such as calcium and vitamin B12, bone fractures, gastrointestinal infections (e.g., <em>Clostridioides difficile<\/em>), potential liver and kidney damage, and drug dependence.<\/div>\n<div>Evidence indicates that:<\/div>\n<div>\u2022 continuing at a higher dose does not reduce the risk of symptom recurrence;<\/div>\n<div>\u2022 only 1 in 10 patients who discontinue PPI therapy may experience a return of symptoms.<\/div>\n<div>Based on systematic reviews evaluated using the GRADE methodology, this is considered a strong recommendation.<\/div>\n","protected":false},"featured_media":2417,"template":"","meta":{"_edit_lock":["1769704915:2"],"_edit_last":["2"],"_thumbnail_id":["2417"],"_wpml_word_count":["167"],"_yoast_wpseo_primary_eta":[""],"_yoast_wpseo_primary_disciplina":["121"],"_yoast_wpseo_primary_tipologia":[""],"wpcf-pacchetto":["SIFACT #1"],"wpcf-bibliografia":["1. Yu EW, Bauer SR, Bain PA et al. Proton pump inhibitors and risk of fractures: a meta-analysis of 11 international studies. Am J Med. 2011;124:519-26. doi: 10.1016\/j.amjmed.2011.01.007.\r\n2. Kwok CS, Arthur AK, Anibueze CI et al. Risk of Clostridium difficile infection with acid suppressing drugs and antibiotics: meta-analysis. Am J Gastroenterol. 2012;107:1011-1019. doi: 10.1038\/ajg.2012.108.\r\n3. Lazarus B, Chen Y, Wilson FP et al. Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease. JAMA Intern Med. 2016;176:238-46. doi: 10.1001\/jamainternmed.2015.7193.\r\n4. Sheen E, Triadafilopoulos G. Adverse effects of long-term proton pump inhibitor therapy. Dig Dis Sci. 2011 ;56:931-50. doi: 10.1007\/s10620-010-1560-3.\r\n5. Danny Jenkins & Ines Modolell. Proton pump inhibitors. BMJ 2023;383:e070752. doi: 10.1136\/bmj-2022-070752."],"wpcf-posizione-prof":["5"],"wpcf-collegare":["N"],"wpcf-link-intercheck-prof":["N"],"wpcf-area-ordinamento":["Clinical Pharmacy and Therapy"],"_wpml_media_duplicate":["0"],"_wpml_media_featured":["0"],"_yoast_wpseo_content_score":["90"],"_yoast_wpseo_focuskeywords":["[]"],"_yoast_wpseo_keywordsynonyms":["[\"\"]"],"_wpml_location_migration_done":["1"],"_layouts_template":["layout-for-raccomandazioni-professionista"],"_wp_page_template":["default"],"cmplz_hide_cookiebanner":[""],"wpcf-parole-chiave-prof":[""],"wpcf-pdfpdf-prosfessionista":["https:\/\/choosingwiselyitaly.org\/wp-content\/uploads\/2018\/10\/Scheda-SIFACT-2024-english-rev.pdf"],"_wpv_contains_gutenberg_views":[""]},"eta":[{"term_id":96,"name":"Adult","slug":"adult","term_group":0,"term_taxonomy_id":96,"taxonomy":"eta","description":"","parent":0,"count":272,"filter":"raw"},{"term_id":97,"name":"Geriatric","slug":"geriatric","term_group":0,"term_taxonomy_id":97,"taxonomy":"eta","description":"","parent":0,"count":242,"filter":"raw"},{"term_id":95,"name":"Pediatric","slug":"pediatric","term_group":0,"term_taxonomy_id":95,"taxonomy":"eta","description":"","parent":0,"count":172,"filter":"raw"}],"disciplina":[121],"tipologia":"Drugs","class_list":["post-2886","raccomandazione-prof","type-raccomandazione-prof","status-publish","has-post-thumbnail","hentry","eta-adult","eta-geriatric","eta-pediatric","disciplina-clinical-pharmacy-and-therapy","tipologia-drugs"],"_links":{"self":[{"href":"https:\/\/choosingwiselyitaly.org\/en\/wp-json\/wp\/v2\/raccomandazione-prof\/2886","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/choosingwiselyitaly.org\/en\/wp-json\/wp\/v2\/raccomandazione-prof"}],"about":[{"href":"https:\/\/choosingwiselyitaly.org\/en\/wp-json\/wp\/v2\/types\/raccomandazione-prof"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/choosingwiselyitaly.org\/en\/wp-json\/wp\/v2\/media\/2417"}],"wp:attachment":[{"href":"https:\/\/choosingwiselyitaly.org\/en\/wp-json\/wp\/v2\/media?parent=2886"}],"wp:term":[{"taxonomy":"eta","embeddable":true,"href":"https:\/\/choosingwiselyitaly.org\/en\/wp-json\/wp\/v2\/eta?post=2886"},{"taxonomy":"disciplina","embeddable":true,"href":"https:\/\/choosingwiselyitaly.org\/en\/wp-json\/wp\/v2\/disciplina?post=2886"},{"taxonomy":"tipologia","embeddable":true,"href":"https:\/\/choosingwiselyitaly.org\/en\/wp-json\/wp\/v2\/tipologia?post=2886"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}