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These regulators converge on glucose transport and core glycolytic enzymes, including HK2, PFKFB3, PKM2 and LDHA. The resulting increase in aerobic glycolysis, pyruvate\u2010to\u2010lactate conversion and lactate export supports biosynthesis, redox homeostasis and survival under metabolic stress. Beyond its bioenergetic role, lactate acts as a signalling metabolite that acidifies and remodels the tumour microenvironment. It impairs CD8\u2010positive T and natural killer cells function, promotes regulatory T cells accumulation and M2 macrophages polarisation, activates stromal cells and facilitates epithelial\u2013mesenchymal transition and immune evasion. Together, tumour\u2010intrinsic metabolic adaptation and lactate\u2010mediated microenvironmental reprogramming contribute to resistance to chemotherapy, targeted therapy and immunotherapy. Translationally, metabolic imaging, circulating LDH and lactate\u2010related markers, exosomal glycolytic enzymes, gene\u2010expression signatures and lactylation\u2010related features may improve prognostic assessment, treatmentresponse prediction and patient stratification. These findings support biomarker\u2010guided combination strategies that target tumour metabolism, lactate production or transport and stromalimmune crosstalk alongside standard therapies. This review uniquely integrates direct GC\u2010derived evidence with indirect evidence from non\u2010GC models and clinical trials and grades biomarkers and metabolic interventions according to their translational maturity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Overall, the Warburg effect represents both a central driver of GC progression and a clinically relevant metabolic vulnerability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>The Warburg effect in gastric cancer is a multi\u2010module metabolic state, not a single glycolytic phenotype.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Lactate links glycolytic reprogramming to stromal activation, immune evasion and therapy resistance.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\n                            Microbiota, especially\n                            <jats:italic>H. pylori<\/jats:italic>\n                            , modulates glycolysis and creates actionable upstream vulnerabilities.\n                          <\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Biomarker\u2010guided combinations, rather than isolated glycolytic inhibition, define the translational path forward.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  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