When considering gastroesophageal reflux, which symptom is least likely to be anticipated?

In the context of gastroesophageal reflux disease (GERD), hematemesis, which refers to the vomiting of blood, is least likely to be anticipated as a symptom. GERD typically involves the backflow of stomach contents into the esophagus, leading to more common symptoms such as heartburn, regurgitation, and discomfort. The presence of blood in vomit is indicative of complications such as esophagitis or other severe gastrointestinal issues, which are not typical symptoms of uncomplicated reflux.

On the other hand, symptoms like eructation (belching), cough, and dysphonia (hoarseness) can all arise due to the irritation of the esophagus and throat by stomach acid. For example, acid can trigger a cough reflex or cause inflammation which can lead to hoarseness. Therefore, while eructation, cough, and dysphonia are often associated with GERD, hematemesis is a more serious symptom and is not a classic presentation of this condition.