Does peri-operative enteral nutrition and immunonutrition alter immunological response to surgery, improve blood supply to the gut and improve clinical outcome of patients undergoing restorative proctocolectomy?

INTERVENTION: Patients will be assigned to one of three groups: Group 1 will receive normal pre‐operative and post‐operative care with no supplemental nutrition. Group 2 will receive one week pre‐operative supplemental enteral nutrition isocalorific and isonitrogenous to IMPACT to provide 25 Kcal/kg/day. Group 3 will receive one week pre‐operative supplemental enteral nutrition with IMPACT to provide 25 Kcal/kg/day. CONDITION: Surgery: Restorative proctocolectomy ; Surgery ; Ulcerative colitis PRIMARY OUTCOME: Peripheral blood leukocyte subsets will be tested for intracellular pro‐inflammatory cytokines InterLeukin‐6 (IL‐6), InterLeukin‐2 (IL‐2) and anti‐inflammatory cytokine InterLeukin‐10 (IL‐10) using the technique of Carrock Sewell et al 1997. Phagocyte activity of both granulocytes and monocytes will be tested directly using fluroescein labeled opsonised bacteria. Blood will be taken prior to feeding, preoperatively, intraoperatively and on postoperative days three and seven. At laparotomy a biopsy of small bowel mucosa will be taken to assess leukocyte subsets for intracellular pro‐inflammatory cytokines IL‐6, IL‐2 and anti‐inflammatory cytokine IL‐10. Phagocyte activity of both granulocytes will be tested directly using fluorescein labeled opsonised bacteria. Two further biopsies will be taken on days three and seven postoperatively for correlation with the peripheral blood immunology. SECONDARY OUTCOME: Not provided at time of registration INCLUSION CRITERIA: 30 patients aged between 18‐65 years old