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Place ground turkey and onion in a large skillet. Turn heat to medium and cook and stir the mixture constantly until the turkey is browned and forms small crumbles, about 10 minutes
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Stir in garlic and green bell pepper; cook and stir until softened, 2 to 3 minutes. Add 1 cup water and stir, scraping the pan to dissolve any brown bits from the bottom of the skillet.
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Mix in ketchup, Worcestershire sauce, brown sugar, salt, pepper and cayenne. Add 1 more cup water and return mixture to a simmer. Reduce heat to low and simmer, stirring occasionally, until the liquid has evaporated and the mixture is thick, about 40 minutes.
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