It has been suggested that in doubtful cases of coeliac disease, a high CD3 + T-cell receptor gamma delta + (TCRγδ + ) intraepithelial lymphocyte count increases the likelihood of coeliac disease. Aim: To evaluate the diagnostic accuracy of both an isolated increase of TCRγδ + cells and a coeliac lymphogram (increase of TCRγδ + plus decrease of CD3 − intraepithelial lymphocytes) evaluated by flow cytometry in the diagnosis of coeliac disease. Methods: The literature search was conducted in MEDLINE and EMBASE. The inclusion criteria were: an article that allows for the construction of a 2 × 2 table of true and false positive and true and false negative values. A diagnostic accuracy test meta-analysis was performed. Results: The search provided 49 relevant citations, of which 6 were selected for the analysis, which represented 519 patients and 440 controls. Coeliac lymphogram: The pooled S and Sp were 93% and 98%, without heterogeneity. The area under the SROC curve (AUC) was 0.98 (95% CI, 0.97-0.99). TCRγδ + : Pooled S and Sp were both 95%, with significant heterogeneity. The AUC was 0.97 (95% CI, 0.95-0.98). Conclusions: Both TCRγδ + count and coeliac lymphogram assessed by flow cytometry in duodenal mucosal samples are associated with a high level of diagnostic accuracy for and against coeliac disease.In addition, the overlap between patients with non-coeliac gluten sensitivity and CD patients with a Marsh type I lesion becomes evident and makes differential diagnosis quite difficult [9,10]. Increasingly, clinicians face the challenge of making a diagnosis of patients who choose to live without gluten, without a previous diagnosis of CD. This is challenging, since both the serology and histology of the small intestine are normalized in patients with CD on a gluten-free diet (GFD). In these circumstances, HLA genotyping is of value, since CD is extremely improbable in patients who are HLA-DQ2/8 negative, though it is insufficient in HLA-DQ2/8 positive patients, since 30-40% of the healthy population are also positive.Other diagnostic approaches beyond conventional histology and serology have been introduced for the diagnosis of CD [11]. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for the Study of Coeliac Disease (ESsCD) guidelines suggest that in doubtful cases, a high CD3 + T-cell receptor gamma delta + (TCRγδ + ) intraepithelial lymphocyte (IEL) count increases the likelihood of CD diagnosis [4,5]. IELs are increased in the mucosa of untreated coeliac patients. In general, these IELs are CD3 + αβ + T-cell-receptor-bearing cells. However, 20-30% of CD3 + IELS are γδ + T-cell-receptor-bearing cells in CD, which comprise fewer than 10% of the IELs in non-coeliac subjects [12]. TCRγδ + IELs are considered to be highly sensitive and specific for CD, and, furthermore, remain elevated despite a GFD [13][14][15]. Non-T-cell CD3 − IELs are the second most abundant IEL subset in healthy mucosa. CD3 − IELs comprise heterogeneous phenotypes, of which the...