Bring a large pot of salted water to a boil and cook the bowtie pasta until al dente. Reserve 1/2 cup pasta water, then drain.

Heat the olive oil in a large skillet over medium heat. Add the sliced smoked beef sausage and cook, stirring occasionally, until browned and slightly crisp (about 5–7 minutes). Remove the sausage to a plate and set aside.

In the same pan, add the chopped onion. Sauté for 3–4 minutes until softened and translucent, scraping up any browned bits from the sausage.

Lower heat to medium. Pour in the heavy cream, add the Parmesan cheese, Cajun seasoning, paprika, and oregano. Stir continuously until the cheese melts and the sauce thickens slightly (2–3 minutes). If the sauce is too thick, loosen with a splash of reserved pasta water.

Add the cooked bowtie pasta to the pan and toss to coat evenly in the sauce. Return the sausage to the skillet and stir for another minute to heat through and marry flavors.

Taste and adjust seasoning with salt and pepper. Serve hot, optionally topped with extra Parmesan and chopped parsley.