Background: Gastric cancer is diagnosed late. Only in countries such as Koreaand Japan there are policies of screening, which would be justified in any country with a high prevalence of gastric cancer such as Colombia or Chile. The analysis of the serum pepsinogen had been proposed for the early diagnosis of premalignant and malignant lesions, the propose is to review systematically the literature the diagnostic value of the quotient pepsinogen I/II as a marker of gastric premalignant and malignant lesions. Methodology: we reviewed the literature until September 2016 with key words malignant and premalignant gastric lesions and pepsinogenin PubMed, OVID, EMBASE, EBSCO, LILACS, Dialnet and OPENGRAY, diagnostic test studies to evaluate the quotient pepsinogen I/II in relation to the histological findings. Results: 21 articles were included with a total of 20601 patients, with a sensitivity of 13.7% - 91.2%, a specificity of 38.5% - 100%, a positive predictive value of 6.3% - 100% and a negative predictive value of 33.3% - 98.8% of the quotient pepsinogen I/II in relation to the diagnosis of gastric premalignant and malignant lesions. Conclusions: The diminished values of the quotient pepsinogen I/II are related to the presence of premalignant and malignant gastric lesions. Given that the test has better specificity than sensitivity, for screening it would be useful for the selection of patients who would benefit from the UGE. More diagnostic test studies are required to validate acutoffpoint that can be used as the standard value.