Reviewed By: Pramod Kerkar, MD, FFARCSI

Autoimmune hepatitis is uncertain to identify. The accurate cause of autoimmune hepatitis is uncertain. It is multifactorial disorder may be associated with hereditary, environmental, hormonal, and immunological factors. Conversely, the onset of more than half of autoimmune hepatitis has been recognized as "unknown trigger factors". Many scientific publications deliberate the probable part of psychological stress, and of the major stress-related hormones, in the pathogenesis of autoimmune disease. It is very difficult to predict the autoimmune hepatitis disorder due to stress.

Psychological Stress is Associated with Relapse in type 1 Autoimmune Hepatitis

There are strong evidence stating that psychological stress is a significant factor that is associated with relapse in type 1 autoimmune hepatitis. Type I is more common tends to affect young women and is associated with other autoimmune diseases. This is the most common form of autoimmune hepatitis in North America and Europe. Stress is also the reason for the incidence of relapse or recrudescence of disease activity in autoimmune hepatitis. Recurring autoimmune hepatitis can lead to the development of cirrhosis and therefore, decreased rate of survival in this disease.

Can Autoimmune Hepatitis be Caused by Stress?

Physical and psychological stress has been implicated in the development of autoimmune disease since numerous animal and human studies demonstrated the effect of sundry stressors on immune function. Moreover, many retrospective studies found that a high proportion (up to 80%) of patients reported uncommon emotional stress before disease onset. Unfortunately, not only does stress cause disease, but the disease itself also causes significant stress in the patients, creating a vicious cycle. Recent reviews discuss the possible role of psychological stress, and of the major stress-related hormones, in the pathogenesis of autoimmune disease. It is presumed that the stress-triggered neuroendocrine hormones lead to immune dysregulation, which ultimately results in autoimmune disease, by altering or amplifying cytokine production.

Mechanism and Measurement of Stress

Psychological stress induces the activation of hypothalamic-pituitary axis and the sympathetic nervous system which ultimately leads to immune dysregulation marked by increased levels of circulating pro-inflammatory cytokines. In autoimmune diseases, augmentation of a pro-inflammatory response could have deleterious effects in tissues that are particularly susceptible to immune stimulation. Stressful life events were measured using the Social Readjustment Rating Scale (SRRS), the most widely known and internationally used life events scaling instrument in clinical research.

Treatment of Stress-Induced Autoimmune Hepatitis

The treatment of an autoimmune disease includes stress management and behavioral intervention to prevent stress-related immune imbalance. Different stress reactions should be discussed with autoimmune patients, and obligatory questionnaires about trigger factors should include psychological stress in addition to infection, trauma, and other common triggers. Management of autoimmune hepatitis may benefit from strategies to reduce stress and promote psychological wellbeing.

Conclusion

Type 1 autoimmune hepatitis cause a progressive necroinflammatory liver disease because of psychological stress. Stress activates the hypothalamic-pituitary axis and the sympathetic nervous system and ultimately leads to immune dysregulation marked by increased levels of circulating pro-inflammatory cytokines. Stress is also the reason for the incidence of relapse or recrudescence of disease activity in autoimmune hepatitis. Management of autoimmune hepatitis may benefit from strategies to reduce stress and promote psychological well-being.

Also Read:

Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: July 9, 2018

This article does not provide medical advice. See disclaimer

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