The early diagnosis and treatment of gastric cancer are essential for the prognosis of patients, and they can be realized by exploring the mechanism of precancerous lesions. Spasmolytic polypeptide expressing metaplasia (SPEM) is an important precancerous lesion of gastric cancer, which is closely related to the occurrence of gastric cancer. However, the specific regulatory mechanism remains unclear. This article focuses on the pathogenesis and development of SPEM as well as its relationship with gastric cancer, which may provide new ideas for the pathogenesis, early prevention and treatment of gastric cancer.