In a large pot or Dutch oven, combine the ground beef, yellow onion, green bell pepper, and garlic. Cook over medium to high heat for about 5 minutes, or until the beef is browned and crumbled. Be sure to drain any excess grease and moisture from the mixture.
Add the tomato sauce, stewed tomatoes, water, Worcestershire sauce, Italian seasoning, salt, and black pepper to the pot. Cover and let it simmer over medium heat for 10 minutes.
Stir in the uncooked elbow macaroni and continue to simmer for an additional 10 to 15 minutes. Make sure to stir frequently and check the macaroni for tenderness.
Once the macaroni is tender, stir in the medium cheddar cheese. Allow the goulash to rest for 5 minutes before serving.
Notes
For a little extra flavor, consider adding a pinch of red pepper flakes for some heat. You can also mix in some frozen vegetables like peas or corn for added nutrition.