Gastroduodenal fistula or double pylorus is a very rare condition. It is a fistulous communication between gastric antrum and duodenal bulb. It can be either congenital or acquired. In most cases it is thought to be a complication of gastric ulcer. We recently experienced a case of gastroduodenal fistula in 70 year-old man presenting as epigastric pain. He was diagnosed with non ST elevation myocardial infarction previously, and was taking aspirin. Gastroduodenal communication was revealed by endoscopy. We report a case of gastroduodenal fistula that developed in man who was taking aspirin, with review of the literature.