The bishopric of Acqui was probably established at the end of the fourth century, likely about the same time as the bishoprics of Novara, Turin, Ivrea, Aosta, Asti and Alba. The first bishop of Acqui was Ditarius. The cathedral of Acqui was erected during Guido, the patron Saint of Acqui, who was bishop between 1034–1070. On 16 May 1205, Pope Innocent III decided to unite the bishoprics of Alessandria and Acqui. Acqui and Alessandria stayed united until 1405, when the bishopric of Alessandria was re-erected.
The only bishop known to have issued coins is Oddone Bellingeri (1305-1333).
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