Therapeutic pyramid for diabetic gastroparesis

A sequential approach to the management of patients with diabetic gastroparesis needs to be considered on the basis of the severity of the symptoms and the efficacy and safety of the intervention. Starting at the base, frequent but mild complications can be treated with simple approaches such as dietary modifications. As the severity of symptoms increases, a more aggressive approach needs to be considered. The peak of the pyramid represents the minority of patients with diabetic gastroparesis that fails to respond to more conventional approaches; in these patients therapeutic options are limited and not necessarily evidence based.