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Intermittent crampy abdominal pain points to the gut contracting against a blockage. This colicky pattern comes from waves of peristalsis that try to push contents past an obstruction, so the pain rises and falls rather than staying constant in one spot.

In a middle-aged patient, this is a classic way bowel obstruction can present, especially when the pain is not localized to a single quadrant and recurs in a rhythmic fashion. Other conditions have different patterns: diverticular disease usually causes localized left-lower-quadrant pain with changes in bowel habits; pancreatitis typically presents as steady, severe upper abdominal pain that may radiate to the back; cholecystitis often causes persistent right upper-quadrant pain with fever and possibly a positive Murphy sign.

So the episodic, crampy nature of the pain makes bowel obstruction the best fit given the presentation.