The cag pathogenicity island genes of Helicobacter pylori (ie, cag1, cag5, cagT, cagE, and cagA) were detected by PCR in DNA extracted from endoscopically collected gastric juice, and the relationship between these genes and gastric disease was studied in 25 patients with early gastric cancer, 9 patients with gastric ulcer, and 15 patients with chronic active gastritis. In three patients with early gastric cancer and one patient with gastric ulcer, cag pathogenicity island genes were amplified although H. pylori was not detected by conventional methods. Compared with conventional methods, the sensitivity of detection of cag genes was 92.3% (36/39) and the specificity was 60% (6/10). Among the patients with cagA amplification, only cagE was not amplified in one case each with early cancer and chronic active gastritis. In addition, none of cag1, cag5, cagT, and cagE were amplified in spite of cagA amplification in one patient with gastric ulcer. This method is a simple procedure, has a high sensitivity, and appears to be useful for accurate assessment of infection with cagA-positive strains. Because deletion of cag PAI genes was found in the patients with all three gastric diseases that we studied, it was suggested that the pathogenicity of H. pylori might not be determined by cag PAI genes in those cases.