BACKGROUND: This study aims to investigate the association between pyroptosis and the outer membrane virulence factor of in patients with gastritis and ulcers. METHODS: DNA, RNA, and protein were extracted from a single tissue sample taken from the antrum region of the stomach of volunteer patients. The expression of bacterial outer membrane virulence genes was analyzed at the gene level, and the expression levels of key pyroptosis markers were compared between -infected and uninfected gastritis and ulcer patient groups. RESULTS: infection induced significant alterations in the expression levels of pyroptosis markers, including , , caspase-1, GSDMD, IL-18, and IL-1β, indicating a strong association with gastritis and ulcer pathology. Statistically significant correlations were observed between elevated levels of these markers and the activation of caspase-1 across different patient cohorts, supporting effective detection of pyroptosis. Both pro and active forms of caspase-1, GSDMD, IL-18, and IL-1β were assessed, revealing pyroptotic activity in specific patient samples. The vacA m2 allele showed a distinct response in gastritis versus ulcer patients and was associated with increased GSDMD expression in ulcerative cases. Along with the gene, this allele appears to play a critical role in the interaction between virulence and host pyroptotic responses. A statistically significant negative association was identified between the presence of the gene and Gasdermin D expression (odds ratio = 0, < 0.01), suggesting that Gasdermin D was absent in all -positive samples. CONCLUSION: This study provides novel insights into the interrelation between the virulence factors of and pyroptosis in gastritis and ulcer diseases. Our findings demonstrate that infection significantly alters the expression levels of pyroptosis markers, including , , caspase-1, GSDMD, IL-18, and IL-1β, in gastric tissues. Notably, the vacA m2 allele was associated with a differential response in expression among patients with gastritis and ulcers, correlating with increased GSDMD levels in ulcerative conditions. The presence of the gene is markedly associated with the lack of Gasdermin D activation, indicating a possible suppressive function or immune evasion tactic. These results underscore the critical role of virulence determinants in modulating pyroptosis and suggest that understanding this relationship may pave the way for developing targeted therapeutic strategies to mitigate -associated pathologies.