Definitely plays a lot smoother on my computer but I have no idea what half the items I get do, like the ones that go in the bottom left of the screen
Those are trinkets. They generally have a hard to notice passive effect, like a better chance or hearts dropping from enemies or a 10% of firing a poisonous shot. Those ones are pretty damn hard to figure out, but at the same time they don't change up the gameplay much.
A lot the fun is figuring out the items, but if you get the same one a few times and still have no clue what it does, then there's no harm in looking it up imo.