One of the prerelease screenshots shows the title screen with the words "Licensed By Nintendo Of America", suggesting that a U.S. release was originally planned.
Some of the content from the pre-release builds of the game was cut during development. One example is that stars would appear when the player starts to use a special ability, and the health bars originally had faces on them. Oddly, you can also see pre-release screenshots on the back of the game's box.
The international release of the game has a far more plain looking "Game Over" screen compared to the Japanese version, which features a fancy Gothic font.
In the Japanese release, the crow enemies attempt to attack the player by dropping feces on them. This was changed in the international release to a 16 ton weight.
The mouse enemies have shorter arms in the international release when compared to the Japanese release.
When the game was localized to the west, it had some notable changes including various plot differences, a completely redone title screen, and the main protagonists Hebe and Oh-Chan were replaced with Bop-Louie and Freeon-Leon.