Objective To investigate the association between exposed cardia glands and gastroesophageal reflux disease (GERD) and identify risk factors for exposed cardia glands. Methods Patients who underwent gastroscopy at Chengde Central Hospital from December 2023 to March 2024 were prospectively enrolled. Patients with exposed cardia glands meeting inclusion criteria comprised the observation group, while controls had no exposed cardia glands but met identical criteria. Demographic, lifestyle, and endoscopic characteristics were compared between the two groups. Results A total of 204 patients were included in the observation group, while 310 in the control group. Univariate analysis demonstrated statistically significant differences between the observation group and the control group in the following factors: body mass index, waist circumference, smoking, alcohol consumption, tea/coffee intake, spicy food preference, sleeping posture, use of calcium channel blockers, Helicobacter pylori infection, peptic ulcer disease, and GERD (P<0.05). Binary logistic regression analysis identified the following independent risk factors for exposed cardia glands: waist circumference (P=0.012, OR=1.070, 95%CI: 1.015-1.129), alcohol consumption (P=0.003, OR=2.166, 95%CI: 1.293-3.631), spicy food preference (P=0.048, OR=1.611, 95%CI: 1.004-2.582), right-side sleeping posture (P<0.001, OR=3.219, 95%CI: 1.696-6.108), use of calcium channel blockers (P<0.001, OR=3.871, 95%CI: 2.263-6.621), Helicobacter pylori infection (P<0.001, OR=3.512, 95%CI: 1.953-6.317), and GERD (P<0.001, OR=2.905, 95%CI: 1.829-4.613). Conclusion Exposed cardia glands demonstrates significant association with GERD. Key independent risk factors include waist circumference, alcohol consumption, spicy diet, right-side sleeping position, calcium channel blockers use, and Helicobacter pylori infection.