Bring a large pot of salted water to a rolling boil. Add the penne pasta and cook until al dente, about 8–10 minutes. Reserve ½ cup of pasta water before draining.

In a large skillet, heat over medium-high heat and crumble in the Italian sausage. Cook for about 5–7 minutes until browned. Add minced garlic and chopped green bell pepper during the last 2 minutes.

Once the sausage is cooked, remove it from the skillet. Lower the heat and pour in a splash of reserved pasta water to deglaze, scraping up the browned bits.

Add the heavy cream to the deglazed pan on low heat. Stir for 3–5 minutes until the sauce thickens. Adjust thickness with more reserved pasta water if necessary.

Return the cooked sausage and drained pasta to the skillet, tossing gently to coat the pasta in the sauce.

Dish out the creamy sausage pasta into bowls and garnish with freshly chopped parsley or basil.