The American release of The Twisted Tales of Spike McFang was slightly altered. The enemies have higher defense and after Spike gains a level, his health doesn't get replenished. As a result, the game was more challenging than its Japanese counterpart. The shopkeeper, Dowson, was originally a pretty blonde girl. In the American version, this was changed to a mummified creature.
Source: Wikipedia, "The Twisted Tales of Spike McFang", available under the CC-BY-SA License.