65-year-old man with long-standing diabetes develops new-onset gastroesophageal reflux symptoms. What is the likely diagnosis and the recommended initial workup?

• A. Diabetic gastroparesis; gastric endoscopy is unnecessary and there is no need for obstruction exclusion.
• B. Endoscopy first to rule out mechanical obstruction, followed by gastric-emptying scintigraphy; may treat with metoclopramide or erythromycin if appropriate.
• C. Gastroesophageal reflux disease without motility issues; begin proton pump inhibitors.
• D. Pyloric stenosis; surgical evaluation.

Answer: (B)