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Episode 2: Diarrhea & NETs  • The LACNETS Podcast

Episode 2: Diarrhea & NETs • The LACNETS Podcast

ABOUT THIS EPISODE: 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. MEET DR. DAVID METZ Dr. Metz is the Professor of Medicine and Co-director of the Neuroendocrine Tumor Program at the University of Pennsylvania. ​He is actively involved in clinical research, patient care, and teaching of students, residents, and fellows. Dr Metz’s clinical research program is particularly active in acid-peptic conditions including hypersecretory states such as Zollinger-Ellison syndrome, Helicobacter pylori infection, nonsteroidal anti-inflammatory drug gastropathy, and gastroesophageal reflux disease. He also has particular expertise in the diagnosis and management of patients with functional and non-functional neuroendocrine tumors of the pancreas and alimentary tract. He has been a principal investigator on a number of trials evaluating upper gastrointestinal disease states. He is also active in national gastroenterology societies and was a prior member of the Liason Committee for Recertification of the American Board of Internal Medicine (American Gastroenterological Association representative), the US Food and Drug Administration Gastrointestinal Drugs Advisory Committee and chair emeritus of the North American neuroendocrine Tumor Society (NANETS). Dr. Metz earned his MBBCh (MD equivalent) from the University of the Witwatersrand in Johannesburg, South Africa. He moved to the United States in 1986 and pursued a residency in internal medicine at Albert Einstein Medical Center in Philadelphia. He completed a fellowship in gastroenterology in Washington, DC, in the combined Georgetown/Veterans Affairs Medical Center/National Institutes of Health (NIH) program. He remained on staff at the NIH for 2 more years as a senior staff fellow, performing basic research in pancreatic acinar cell secretion and clinical research in Zollinger-Ellison syndrome specifically. In 1993, Dr. Metz moved to Philadelphia in the role of Assistant Professor in the clinician educator track at the University of Pennsylvania. He was promoted to Associate Professor in 1998 and Full Professor in 2003. TOP 10 QUESTIONS 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? For more resources and a transcript of this episode, visit
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