Background/Aims: Patients with gastric cancer in some Asian populations were infected more frequently with hrgA-positive H. pylori. The aim of this study was to examine the usefulness of hrgA to predict the clinical outcome of H. pylori infection. Methodology: Forty-four patients with gastric cancer (35 intestinal and 9 diffuse type cancer) and 51 control subjects were studied. Presence of hrgA gene in H. pylori strains isolated from biopsy specimens was examined by PCR. Biopsy specimens were also obtained for histological assessment of gastritis. Results: Nine of 44 patients with gastric cancer (20.4%) and 11 of 51 control subjects (21.6%) were infected with hrgA-positive strain (NS). In patients with gastric cancer, prevalence of hrgA-positive strain was 20.0% in patients with intestinal type cancer (7/35) and 22.2% with diffuse type cancer (2/9) (NS). In control subjects, the prevalence of hrgA-positive infection was not associated with gastric mucosal inflammatory infiltration and glandular atrophy. Conclusions: Infection with hrgA-positive strain was not frequent among patients with gastric cancer. Presence of hrgA gene would not be a useful marker to predict clinical outcome of patients infected with H. pylori in this series of Japanese patients.