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For our second episode, NET expert and gastroenterologist Dr. David Metz answers the top 10 GI questions for NETs. Dr. Metz addresses diarrhea, diet, the difference between carcinoid tumor vs. carcinoid syndrome, and effective symptom management.



David C. Metz, MD

Professor of Medicine, Perelman School of Medicine

Co-Director Emeritus, University of Pennsylvania Neuroendocrine Tumor Program

After earning his MD from the University of the Witwatersrand's Medical School, Dr. Metz was a resident at both the Albert Einstein Medical Center and the Johannesburg General Hospital. He went on to complete fellowships at Georgetown University Hospital as well as the National Institutes of Health.

Arriving at Penn Medicine in 1993, David Metz, MD, held a variety of leadership roles within the Department of Gastroenterology, including Co-Directorship of the Neuroendocrine Tumor Center and Penn NET Treatment Program. Dr. Metz was previously a staff fellow at the National Institutes of Health, where he performed basic research in pancreatic acinar cell secretion and clinical research in Zollinger-Ellison syndrome. While at Penn Medicine, he served as Chair of the North American Neuroendocrine Tumor Society (NANETS), as a member of the Liaison Committee for Recertification of the American Board of Internal Medicine (American Gastroenterological Association representative), and on the Food and Drug Administration Gastrointestinal Drugs Advisory Committee, among other positions.

Dr. Metz's clinical interests at Penn included Zollinger-Ellison syndrome and other acid-peptic conditions, Helicobacter pylori infection, non-steroidal anti-inflammatory drug gastropathy and the diagnosis and management of patients with functional and non-functional neuroendocrine tumors of the pancreas and alimentary tract. An investigator for a series of prominent clinical trials in all of these areas, Dr. Metz has published more than 200 articles on topics of clinical interest and research. He retired in July 2021 after 28 years at Penn Medicine. 

In 2021 Dr. Metz received the NANETS Lifetime Achievement Award that honors an individual who, over the course of their career, has provided outstanding contributions to neuroendocrine disease management through research, clinical practice or educational initiatives, as well as exceptional leadership in NANETS and dedication to its mission.



  1. What is the difference between carcinoid syndrome and carcinoid tumor?

  2. What are the most common causes of diarrhea? How do I know if my diarrhea is from NET, medication, diet, or another reason? (What is the difference between diarrhea and fat-absorption diarrhea?")

  3. How do I know if diarrhea is part of carcinoid syndrome or not?

  4. Discuss cramping, bloating, and abdominal pain. Is this part of carcinoid syndrome? (How do I know if these are from the tumor, treatment, or something else?)

  5. Why do they take out the gallbladder and what effect does this have on GI symptoms?

  6. Are there other syndromes besides carcinoid syndrome that cause diarrhea?

  7. How might my doctor evaluate my diarrhea? When should someone have EGD, colonoscopy, and capsule endoscopy and how might it affect symptom management?

  8. What do I do to control my diarrhea?  

  9. What treatment/diet/meds would help prevent chronic cramping, bloating, loud gurgling of GI tract for a midgut patient on SSAs ?

  10. What is the best diet for diarrhea?    



LACNETS Podcasts are created for educational purposes only and do not substitute for medical advice. The views shared in this Podcast are the personal opinions of the experts and do not necessarily reflect the views of LACNETS. Please contact your medical team with questions or concerns about your individual care or treatment.



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