Dietary indices are widely used in diet quality measurement, and the index-based dietary patterns are related to gastric cancer risk. To evaluate the relationship between different kinds of index-based dietary patterns and gastric cancer risk, we systematically searched four English-language databases and four Chinese-language databases. The quality of studies was assessed by the Newcastle-Ottawa Scale. Meta-analyses were performed to estimate the association between gastric cancer incidence and different types of index-based dietary patterns. The odds ratios (OR) and hazard ratios (HR) of gastric cancer incidence were calculated by regression models in case-control studies and prospective cohort studies, respectively. The studies were pooled in the random-effects model to calculate the summarized risk estimate of the highest quantile interval of dietary indices, taking the lowest as the referent. The dietary indices included different versions of Mediterranean diet score (MDS) and dietary inflammatory index (DII), healthy eating index, Chinese food pagoda score, and food index score. The meta-analysis was carried out for studies on MDS and DII. The combined OR of gastric cancer for the highest MDS versus the referent was 0.42 (95% CI 0.2–0.86), and the combined HR was 0.89 (95% CI 0.68–1.17). The combined OR for DII was 2.11 (95% CI 1.41–3.15). Higher Mediterranean dietary pattern consumption might reduce gastric cancer risk, while higher inflammatory diet pattern consumption might increase gastric cancer risk.