Pepper (Capsicum spp.) has a long domestication history and has accumulated diverse fruit shape variations. The illustration of the mechanisms underlying different fruit shape is not only important for clarifying the regulation of pepper fruit development but also critical for fully understanding the plant organ morphogenesis. Thus, in this study, morphological, histological and transcriptional investigations have been performed on pepper accessions bearing fruits with five types of shapes. From the results it can be presumed that pepper fruit shape was determined during the developmental processes before and after anthesis, and the anthesis was a critical developmental stage for fruit shape determination. Ovary shape index variations of the studied accessions were mainly due to cell number alterations, while, fruit shape index variations were mainly attributed to the cell division and cell expansion variations. As to the ovary wall thickness and pericarp thickness, they were regulated by both cell division in the abaxial-adaxial direction and cell expansion in the proximal-distal and medio-lateral directions. Transcriptional analysis discovered that the OFP-TRM and IQD-CaM pathways may be involved in the regulation of the slender fruit shape and the largest ovary wall cell number in the blocky-shaped accession can be attributed to the higher expression of CYP735A1, which may lead to an increased cytokinin level. Genes related to development, cell proliferation/division, cytoskeleton, and cell wall may also contribute to the regulation of helical growth in pepper. The insights gained from this study are valuable for further investigations into pepper fruit shape development.