In a 6- or 7-quart cast iron Dutch oven (or other large, heavy pot), heat oil over medium-high heat. Add the sausage, bell pepper, and onion. Cook, stirring, until the sausage browns and the vegetables soften, about 7-8 minutes. Add the garlic and cook, stirring constantly, for 1 more minute. Transfer the sausage and vegetables to a plate; wipe the pot clean.
In the same pot, melt the butter over medium heat. Whisk in the flour; cook, whisking constantly, for 1 minute. Whisk in the milk, Cajun seasoning, and salt. Bring to a boil over medium-high heat, whisking constantly. Continue whisking until thickened, about 2 minutes. Turn off the heat and stir in the cheese until melted and completely smooth.
Add the cooked pasta, sausage, and vegetables to the cheese sauce and stir until combined. Taste and season with additional salt, pepper, or Cajun seasoning if necessary.