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Cook the Pasta: In a large pot of salted boiling water, cook the pasta according to package instructions until al dente. Drain and set aside, reserving a cup of pasta water.
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Brown the Sausage: In a large skillet over medium heat, add the olive oil. Add the sausage, breaking it up with a spoon. Cook until browned and cooked through, about 5-7 minutes. Remove the sausage from the skillet and set aside.
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Sauté the Vegetables: In the same skillet, add the sliced bell pepper and onion. Sauté for about 4-5 minutes until softened. Add the minced garlic and cook for an additional minute, until fragrant.
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Make the Sauce: Pour in the heavy cream and stir to combine. Add the Italian seasoning, salt, and black pepper. Bring to a simmer and cook for 2-3 minutes, allowing the sauce to thicken slightly.
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Combine Pasta and Sausage: Return the cooked sausage to the skillet and stir in the cooked pasta. Add the grated Parmesan cheese, mixing until everything is well coated. If the sauce is too thick, add a little reserved pasta water to reach your desired consistency.
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Serve: Remove from heat and garnish with fresh basil or parsley. Serve warm, with extra Parmesan cheese on the side if desired.
