AIM:To investigate the expression of ornithine decarboxylase (ODC) in precancerous and cancerous gastric lesions.METHODS: We studied the expression of ODC in gastric mucosa from patients with chronic superficial gastritis (CSG, n = 32), chronic atrophic gastritis [CAG, n = 43;15 with and 28 without intestinal metaplasia (IM)],gastric dysplasia (DYS, n = 11) and gastric cancer (GC,n = 48) tissues using immunohistochemical staining. All 134 biopsy specimens of gastric mucosa were collected by gastroscopy.METHODS: The positive rate of ODC expression was 34.4%, 42.9%, 73.3%, 81.8% and 91.7% in cases with CSG, CAG without IM, CAG with IM, DYS and GC, respectively (P ＜ 0.01), The positive rate of ODC expression increased in the order of CSG ＜ CAG (without IM) ＜ CAG (with IM) ＜ DYS and finally, GC. In addition,ODC positive immunostaining rate was lower in welldifferentiated GC than in poorly-differentiated GC (P ＜0.05).CONCLUSION: The expression of ODC is positively correlated with the degree of malignity of gastric mucosa and development of gastric lesions. This finding indicates that ODC may be used as a good biomarker in the screening and diagnosis of precancerous lesions.