Evolutionary Medicine for Chronic Inflammatory Diseases of the Gut: More Than a Clinical Fantasy?

Evolutionary medicine applies the principles of evolution to improve patient health (Box 1).1,2 Several clinical disciplines3, 4, 5 already incorporate evolution, and it has begun to receive attention in gastroenterology.6 Four recent experimental studies show evolutionary adaptation of gut bacteria to intestinal inflammation within weeks,7, 8, 9, 10 and an analysis of the intestinal microbiome of patients with inflammatory bowel disease (IBD) identified inflammation-adapted bacterial lineages that evolved over millions of years.11 These findings lay the foundation for evolutionary medicine in patients with chronically inflamed intestines. We see the rise of a new era in gastroenterology therapy with the potential for novel, evolution-informed treatment options ahead.