Place a pot of water on the stove and turn to high heat to boil for the pasta.
Meanwhile, heat the oil in a large, heavy skillet over medium heat. Add the sausages and cook until brown on all sides, 7 to 10 minutes. Remove the sausages from the pan.
Keeping the pan over medium heat, add the bell peppers, onions, salt, and pepper and cook until golden, 5 minutes. Add the garlic, oregano, and basil and cook for 2 minutes. Add the tomato paste and stir until incorporated, then add the Marsala, tomatoes with their juice, and red pepper flakes, if using. Stir to combine, scraping the bottom of the pan with a wooden spoon to release all the brown bits. Bring to a simmer.
When the water boils, add some salt and the pasta and stir. Cook until al dente, according to package instructions, typically about 12 minutes.
Cut the sausages into 4 to 6 pieces each. Return the sausages to the pan. Simmer uncovered until the sausage is cooked through and the sauce has thickened slightly, about 5-7 minutes.
When the pasta is finished cooking, add it to the sauce and stir to coat. Reserve some of the pasta water to add to the sauce if it is too thick. Serve with Parmesan cheese, if desired.