In large saucepan, over medium heat, crumble and cook sausage, onion and green peppers until sausage is browned.
Stir in tomato sauce, tomatoes, water, Worcestershire sauce, chili powder and Italian seasoning.
Bring to a boil. Reduce heat to low, cover and simmer for 15 minutes.
Add elbow macaroni and stir well. Recover and simmer for 15-20 minutes or until macaroni is tender. Serve topped with cheddar cheese.