A 45-year-old man with alcohol use presents with abdominal pain after meals; he denies vomiting and diarrhea. Vitals: BP 140/90, RR 20. What is the likely diagnosis?

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Pain after meals in a patient with a history of heavy alcohol use strongly points to pancreatitis. Alcohol is a major risk factor that can inflame and injure the pancreas, leading to mid-epigastric pain that can radiate to the back. The timing after meals is meaningful because eating stimulates pancreatic enzyme release, which can worsen inflammation and pain in pancreatitis.

Peptic ulcer disease could cause epigastric pain as well, but the pattern is different: duodenal ulcers tend to improve with meals, while gastric ulcers worsen with meals. Gastritis from alcohol can produce similar pain, but the post-meal pattern plus the prominent alcohol history makes pancreatitis more likely.

Bowel obstruction usually presents with vomiting and abdominal distension with colicky, crampy pain, not simply post-meal epigastric pain, and vomiting is commonly present.

So the combination of alcohol use and postprandial epigastric pain best fits pancreatitis.