The relationship between Uric acid (UA) and malignant tumor are still confusing. Gastric cancer(GC) is recognized to be closely related to Helicobacter pylori (H. pylori) infection, early diagnosis rate is very low. In this study, we aimed to investigate the relationship between H. pylori and hyperuricemia (HUA), and evaluate the predictive value of serum uric acid (SUA) in gastric precancerous lesion (GPL) and gastric cancer (GC). This retrospective study included 486 patients who underwent gastroscopy (155 controls, 272 GPL, 59 GC patients). The risk factors for GPL and GC were identified by multiple logistic regression analysis and nomogram was constructed to evaluate the ability of SUA to predict the risk of these diseases based on SUA score. We found that in healthy controls, HUA is positively correlated with H. Pylori (+). SUA was an independent risk factor for GPL and GC. Verification shows that the nomogram was better fitted for GC than for GPL. In conclusion, our study established nomogram based on SUA to predict the risk of GPL and GC, suggested that the incidence of GPL and GC is higher in H. pylori (+) HUA patients, so early intervention and vigilance should be raised.