Helicobacter pylori (H. pylori) chronically colonizes human gastric epithelium and induces various diseases. But the mechanism of carcinogenesis in H. pylori infection remains to be assessed. We described that after attachment of H. pylori to gastric epithelial cells, CagA is injected directly from the bacteria into the cells and undergoes tyrosine phosphorylation. Tyrosine phosphorylated CagA can bind to SHP-2. Deregulation of SHP -2 by CagA may induce abnormal proliferation and movement of gastric epithelial cells. There are two patterns of CagA motifs between East Asian strains and Western strains. East Asian-type CagA confers stronger SHP-2 binding and transforming activities than Western-type CagA. We assessed the association between CagA diversity and clinical outcome in Asian countries, where mortalities from gastric cancer is different. As results, H. pylori infection with East Asian-type CagA was associated with gastric atrophy and cancer. Therefore, persistent active inflammation induced by the East Asian CagA-positive strain may play a role in the pathogenesis of disease.