Helicobacter pylori-negative gastric cancer (HpNGC) is known as a rare disease. We demonstrated its prevalence was less than 1% of all gastric cancers in Japan. Patients with HpNGC were younger, and not as predominantly male. The prevalence of diffuse type histology (especially signet ring cell carcinoma) and superficial depressed appearance was significantly higher than ordinary gastric cancer. A half of HpNGCs expressed intestinal type mucus as well as gastric type. Along with the decrease of Hp infection and widespread of eradication therapy, the incidence of gastric cancer will dramatically decrease in the future.