Gastroduodenal fistula (GDF) or double pylorus is a rare, often asymptomatic condition with a prevalence of approximately 0.02-0.08%. The reported cases have been mainly in Asian countries and more prevalent in males than females. Although the etiology is unclear, and nonsteroidal anti-inflammatory drug use have been associated with the formation of GDF. We present the case of a 65-year-old female with alcoholic cirrhosis and recurrent vomiting who was found to have an antral ulcer. The case includes the serial endoscopic examinations over the period of 7 years and shows the antral ulcer which fistulized into the duodenal bulb creating double pylorus.